MEDICARE: MELISSA EYE ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5423TG	TX

General Provider Information

NPI Number	:	1093251340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELISSA EYE ASSOCIATES

Provider Business Mailing Address
First Line	:	3591 MCKINNEY STREET
Second Line	:	STE. 200
City	:	MELISSA
State	:	TX
Zip	:	75454-9571
Country	:	US
Telephone Number	:	972-837-2222
Fax Number	:	972-837-2223

Provider Business Practice Location Address
First Line	:	3591 MCKINNEY STREET
Second Line	:	STE. 200
City	:	MELISSA
State	:	TX
Zip	:	75454-9571
Country	:	US
Telephone Number	:	972-837-2222
Fax Number	:	972-837-2223

Authorized Official
Title or Position	:	OWNER
Name	:	MR. COLY BRETT MARSH
Credential	:	O.D.
Telephone Number	:	972-837-2222

Provider Enumeration Date	:	01/10/2017
Last Update Date	:	07/21/2022

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