Healthcare Provider Details

I. General information

NPI: 1154493500
Provider Name (Legal Business Name): MELINDA LEE HICKS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 CROSSROADS BLVD
GRAND JUNCTION CO
81506-3954
US

IV. Provider business mailing address

2737 CROSSROADS BLVD
GRAND JUNCTION CO
81506-3954
US

V. Phone/Fax

Practice location:
  • Phone: 970-243-9681
  • Fax: 970-243-9155
Mailing address:
  • Phone: 970-243-9681
  • Fax: 970-243-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1453
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: