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General NPI Number Information
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NPI Number | 1902354459
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Entity Type | Organization
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Legal Business Name | MELISSA M WILLEY OD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 2628 GATEWAY RD STE 125
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City | CARLSBAD
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State | CA
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Zip | 92009-1777
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Country | US
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Telephone | 760-237-8777
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Fax | 760-237-8773
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Provider Business Mailing Address
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Address Line | 6418 KINGLET WAY
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City | CARLSBAD
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State | CA
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Zip | 92011-2700
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Country | US
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Telephone | 760-525-5421
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MELISSA MARIE WILLEY
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Credential | O.D.
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Telephone | 760-525-5421
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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 | 14415
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License Number State | CA
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