Healthcare Provider Details

I. General information

NPI: 1992205363
Provider Name (Legal Business Name): MELISSA D MACCO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10038 MEADOW WAY UNIT A
TRUCKEE CA
96161-4974
US

IV. Provider business mailing address

3524 HERONS CIR
RENO NV
89502-7793
US

V. Phone/Fax

Practice location:
  • Phone: 530-587-1086
  • Fax:
Mailing address:
  • Phone: 510-491-5316
  • Fax: 775-359-2676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1012
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: