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General NPI Number Information
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NPI Number | 1497878508
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Entity Type | Organization
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Legal Business Name | MELODY F. VEGA
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 605 E IMPERIAL HWY SUITE C
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City | BREA
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State | CA
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Zip | 92821-5627
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Country | US
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Telephone | 714-257-1660
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Fax | 714-257-1662
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Provider Business Mailing Address
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Address Line | 605 E IMPERIAL HWY SUITE C
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City | BREA
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State | CA
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Zip | 92821-5627
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Country | US
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Telephone | 714-257-1660
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Fax | 714-257-1662
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Authorized Official
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Title or Position | OWNER
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Name | MS. MELODY F. VEGA
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Credential |
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Telephone | 714-257-1660
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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 | OPT 12660 TPA
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License Number State | CA
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