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General NPI Number Information
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NPI Number | 1568897890
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Entity Type | Individual
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Provider Name | MELISSA ANN DIAMOND O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 02/10/2018
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Provider Practice Location Address
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Address Line | 9520 MALL RD
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City | MORGANTOWN
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State | WV
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Zip | 26501-8524
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Country | US
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Telephone | 304-983-6557
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Fax |
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Provider Business Mailing Address
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Address Line | 146 MAPLE HL
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City | WAYNESBURG
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State | PA
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Zip | 15370-8219
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Country | US
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Telephone | 724-986-4258
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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 | 2005-IOD
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG002787
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License Number State | PA
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