Healthcare Provider Details

I. General information

NPI: 1629254867
Provider Name (Legal Business Name): MELICHER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5465 MOUNTAIN IRON DR SUITE 700
VIRGINIA MN
55792-3372
US

IV. Provider business mailing address

4369 OLAUGHLIN DR
EVELETH MN
55734-4029
US

V. Phone/Fax

Practice location:
  • Phone: 218-741-3000
  • Fax: 218-741-0800
Mailing address:
  • Phone: 218-744-3288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberMN 2409
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY DAVID MELICHER
Title or Position: PRESIDENT
Credential: O.D.
Phone: 218-744-3288