Physician Compare National (NPI:1629153853)

HEALTHCARE PROVIDER: RANDALL GEORGE MELCHERT OD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1629153853
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5799873840
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20071127000028
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MELCHERT
	Individual professional last name
Provider First Name	RANDALL
	Individual professional first name
Provider Middle Name	G
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	ILLINOIS COLLEGE OF OPTOMETRY AT CHICAGO
	Individual professional's medical school
Graduation Year	1978
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	12750 W CAPITOL DR
	Group Practice or individual's line 1 address
City	BROOKFIELD
	Group Practice or individual's city
State	WI
	Group Practice or individual's state
Zip Code	530052467
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2627812020
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y