Healthcare Provider Details

I. General information

NPI: 1588143739
Provider Name (Legal Business Name): MELINDA THOMAS DE JESUS OD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELINDA GINEL THOMAS

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 N GRAND AVE
COVINA CA
91724-2046
US

IV. Provider business mailing address

2604 S MOORLAND PL
WEST COVINA CA
91792-1936
US

V. Phone/Fax

Practice location:
  • Phone: 626-967-3794
  • Fax: 626-967-8404
Mailing address:
  • Phone: 805-889-1217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT34028TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: