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General NPI Number Information
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NPI Number | 1124078829
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Entity Type | Individual
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Provider Name | EDWARD KARL MELBERG O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2677 S PRAIRIE VIEW RD
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-7506
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Country | US
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Telephone | 715-726-1671
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Fax | 715-726-1587
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Provider Business Mailing Address
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Address Line | 16757 121ST AVE
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-6173
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Country | US
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Telephone | 715-288-6115
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1822
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License Number State | WI
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