1184621005 NPI number — DR. MELANIE LYNN LINDERER O.D.

Table of content: DR. MELANIE LYNN LINDERER O.D. (NPI 1184621005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184621005 NPI number — DR. MELANIE LYNN LINDERER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINDERER
Provider First Name:
MELANIE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NELSON
Provider Other First Name:
MELANIE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184621005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 W FRANKLIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIBERTY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64068-1636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-781-2100
Provider Business Mailing Address Fax Number:
816-781-2106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6708 RAYTOWN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAYTOWN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-353-1872
Provider Business Practice Location Address Fax Number:
816-353-5022
Provider Enumeration Date:
07/07/2005

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: 152W00000X , with the licence number:  MO2003015398 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0060721 . This is a "TRICARE PROVIDER NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: DC3193 . This is a "MEDICARE RAILROAD GROUP #" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: P00205607 . This is a "MEDICARE RAILROAD PIN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 337219710 . This is a "BNDD NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: MO2003015398 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 33475028 . This is a "BCBS NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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