MEDICARE: MELISSA NANCY RANDECKER O.D.

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	OET08717	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164506739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA NANCY RANDECKER O.D.

Provider Business Mailing Address
First Line	:	930 BELLEFONTE AVE
Second Line	:
City	:	LOCK HAVEN
State	:	PA
Zip	:	17745-2754
Country	:	US
Telephone Number	:	570-748-8900
Fax Number	:	570-748-3200

Provider Business Practice Location Address
First Line	:	930 BELLEFONTE AVE
Second Line	:
City	:	LOCK HAVEN
State	:	PA
Zip	:	17745-2754
Country	:	US
Telephone Number	:	570-748-8900
Fax Number	:	570-748-3200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	10/20/2022

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Directions to “ MELISSA NANCY RANDECKER O.D.” Practice Location

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