MEDICARE: DR. MELISSA TATE LINDOW OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	35455	CA

General Provider Information

NPI Number	:	1134804891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA TATE LINDOW OD

Provider Business Mailing Address
First Line	:	31978 AVENIDA ENRIQUE
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92591-2145
Country	:	US
Telephone Number	:	951-795-2544
Fax Number	:

Provider Business Practice Location Address
First Line	:	3434 4TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-4911
Country	:	US
Telephone Number	:	619-222-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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