MEDICARE: DR. WILLIAM EDWARD MELZER O.D.

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	CA6511T	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GX462A	OTHER		MEDICARE PTAN

General Provider Information

NPI Number	:	1487723953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM EDWARD MELZER O.D.

Provider Business Mailing Address
First Line	:	6133 BRISTOL PKWY
Second Line	:	SUITE 100
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6609
Country	:	US
Telephone Number	:	310-641-8000
Fax Number	:	310-641-8089

Provider Business Practice Location Address
First Line	:	6133 BRISTOL PKWY
Second Line	:	SUITE 100
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6609
Country	:	US
Telephone Number	:	310-641-8000
Fax Number	:	310-641-8089

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	04/22/2013

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