Healthcare Provider Details

I. General information

NPI: 1669760799
Provider Name (Legal Business Name): MELISSA MARIE PUZZO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA MARIE GORSKI O.D.

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9390 W CROSS DR
LITTLETON CO
80123-2202
US

IV. Provider business mailing address

1755 S BEELER ST UNIT 10G
DENVER CO
80247-2912
US

V. Phone/Fax

Practice location:
  • Phone: 720-922-1539
  • Fax:
Mailing address:
  • Phone: 407-308-8125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 4972
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number56 007744
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT3248
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: