Healthcare Provider Details

I. General information

NPI: 1053511345
Provider Name (Legal Business Name): MELINDA L HICKS, O.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
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 TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1453
License Number StateCO

VIII. Authorized Official

Name: JOAN M MILHOLLAND
Title or Position: ACCOUNTS MANAGER
Credential:
Phone: 970-243-9681