Healthcare Provider Details

I. General information

NPI: 1790320216
Provider Name (Legal Business Name): MELISSA A. DIAMOND, OD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 WHITE HALL BLVD
FAIRMONT WV
26554-8226
US

IV. Provider business mailing address

2690 WHITE HALL BLVD
FAIRMONT WV
26554-8226
US

V. Phone/Fax

Practice location:
  • Phone: 304-363-4533
  • Fax:
Mailing address:
  • Phone: 304-363-4533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MELISSA ANN DIAMOND
Title or Position: OPTOMETRIST
Credential: OD
Phone: 724-986-4258