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General NPI Number Information
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NPI Number | 1275912800
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Entity Type | Organization
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Legal Business Name | MELODY TAVAKOLI O.D., PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/28/2015
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 700 E NAPLES CT
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City | CHULA VISTA
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State | CA
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Zip | 91911-6821
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Country | US
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Telephone | 818-516-8753
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3358
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City | SAN DIEGO
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State | CA
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Zip | 92163-1358
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELODY TAVAKOLI
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Credential | O.D.
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Telephone | 818-516-8753
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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 | 14039TLG
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License Number State | CA
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