Healthcare Provider Details

I. General information

NPI: 1760466148
Provider Name (Legal Business Name): MELANIE M CHIESA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 E MONTE VISTA AVE
TURLOCK CA
95382-0403
US

IV. Provider business mailing address

991 E MONTE VISTA AVE
TURLOCK CA
95382-0403
US

V. Phone/Fax

Practice location:
  • Phone: 209-634-8591
  • Fax: 209-634-8596
Mailing address:
  • Phone: 209-634-8591
  • Fax: 209-634-8596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10303T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: