Healthcare Provider Details

I. General information

NPI: 1306220785
Provider Name (Legal Business Name): MELISSA OCHLAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 MAIN AVE
CLIFTON NJ
07011-2146
US

IV. Provider business mailing address

357 BUCHANAN AVE
STATEN ISLAND NY
10314-4107
US

V. Phone/Fax

Practice location:
  • Phone: 646-423-2781
  • Fax:
Mailing address:
  • Phone: 646-423-2781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00660600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number56008349
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: