1245309228 NPI number — MS. MELODY F VEGA OPTICIAN

Table of content: MS. MELODY F VEGA OPTICIAN (NPI 1245309228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245309228 NPI number — MS. MELODY F VEGA OPTICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VEGA
Provider First Name:
MELODY
Provider Middle Name:
F
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OPTICIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VEGA
Provider Other First Name:
MELODIA
Provider Other Middle Name:
F
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OPTICIAN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1245309228
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
605 E IMPERIAL HWY STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92821-5627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-257-1660
Provider Business Mailing Address Fax Number:
714-257-1662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 E IMPERIAL HWY STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92821-5627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-257-1660
Provider Business Practice Location Address Fax Number:
714-257-1662
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  SL1397 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 421585746 . This is a "UFCW" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0205 . This is a "NVA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 39044 . This is a "AVESIS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 421585746 . This is a "PRINCIPAL LIFE INS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 34718 . This is a "DAVIS VISION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CA 7663 . This is a "EYEMED VSION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 190540 . This is a "VSION PLAN OF AMERICA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PPO62133 HMO62134 . This is a "SAFEGUARD VISION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 42415 . This is a "MES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: VS28 . This is a "SMILE SAVER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 3165 . This is a "COAST TO COAST VISION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 421585746 . This is a "SUPERIOR VISION PLAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ST211441 . This is a "CLARITY VISION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 421585746 . This is a "BLUE CROSS OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 421585746 . This is a "CIGNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 421585746 . This is a "GREAT WEST INSURANCE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 73292 . This is a "UNITED HEALTH CARE/SPECTERA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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