Healthcare Provider Details

I. General information

NPI: 1912160540
Provider Name (Legal Business Name): MELISSA PHYLLIS HJELDEN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA PHYLLIS SAMUELSON OD

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 SOUTH MAIN ST
WATFORD CITY ND
58854
US

IV. Provider business mailing address

1005 SOUTH MAIN ST
WATFORD CITY ND
58854
US

V. Phone/Fax

Practice location:
  • Phone: 701-444-3221
  • Fax: 701-401-2448
Mailing address:
  • Phone: 701-444-3221
  • Fax: 701-401-2448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3131
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1933
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number706
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: