Healthcare Provider Details

I. General information

NPI: 1508944562
Provider Name (Legal Business Name): MELANIE LYNN HOM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 30TH ST SUITE #201
OAKLAND CA
94609-3235
US

IV. Provider business mailing address

491 30TH ST SUITE #201
OAKLAND CA
94609-3235
US

V. Phone/Fax

Practice location:
  • Phone: 510-836-2122
  • Fax: 510-836-3773
Mailing address:
  • Phone: 510-836-2122
  • Fax: 510-836-3773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA86406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: