Healthcare Provider Details

I. General information

NPI: 1407291248
Provider Name (Legal Business Name): MELISSA M DAVID OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 E US 23
EAST TAWAS MI
48730-9329
US

IV. Provider business mailing address

PO BOX 509
EAST TAWAS MI
48730-0509
US

V. Phone/Fax

Practice location:
  • Phone: 989-362-3478
  • Fax: 989-362-2380
Mailing address:
  • Phone: 989-362-3478
  • Fax: 989-632-2380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateMI

VIII. Authorized Official

Name: MELISSA MARIE DAVID
Title or Position: OWNER/PROVIDER
Credential: O.D
Phone: 989-362-3478