Healthcare Provider Details

I. General information

NPI: 1689865180
Provider Name (Legal Business Name): MELISSA JO HULL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA JO HEDMAN OD

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 SW EMIGRANT AVE
PENDLETON OR
97801-1843
US

IV. Provider business mailing address

545 HEMLOCK ST
LAKE OSWEGO OR
97034-6321
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-3653
  • Fax: 541-966-4322
Mailing address:
  • Phone: 503-866-6857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3235ATI
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: