MEDICARE: MELISSA V MERCER 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	OPC3524	FL

General Provider Information

NPI Number	:	1558353466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA V MERCER O.D.

Provider Business Mailing Address
First Line	:	5885 GUNN HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-4007
Country	:	US
Telephone Number	:	813-908-0100
Fax Number	:	813-908-0099

Provider Business Practice Location Address
First Line	:	5885 GUNN HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-4007
Country	:	US
Telephone Number	:	813-908-0100
Fax Number	:	813-908-0099

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	01/24/2012

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