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General NPI Number Information
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NPI Number | 1376554147
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Entity Type | Individual
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Provider Name | MELISSA DEANN GARDNER O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5744 ANTIOCH RD
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City | MERRIAM
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State | KS
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Zip | 66202-2015
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Country | US
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Telephone | 913-362-9131
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Fax |
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Provider Business Mailing Address
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Address Line | 1507 NW 79TH TER
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City | KANSAS CITY
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State | MO
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Zip | 64118-6490
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Country | US
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Telephone | 816-804-6336
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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 | 1507
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License Number State | KS
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