1114587946 NPI number — DR MELISSA WALTERS OPTOMETRIST PLLC

Table of content: DR. ROBERT C. MAY MD (NPI 1376585257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114587946 NPI number — DR MELISSA WALTERS OPTOMETRIST PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR MELISSA WALTERS OPTOMETRIST PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114587946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 WOOLF LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ITHACA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14850-9551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-333-1633
Provider Business Mailing Address Fax Number:
607-241-9951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2230 N TRIPHAMMER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ITHACA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14850-6513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-391-0343
Provider Business Practice Location Address Fax Number:
607-241-9951
Provider Enumeration Date:
06/14/2019

Additional Information

Authorized Official

Authorized Official Last Name:
WALTERS
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
607-333-1633

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com