MEDICARE: ODETTE MELENDEZ

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	156FX1800X	Optician	41585	CA

General Provider Information

NPI Number	:	1316581051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ODETTE MELENDEZ

Provider Business Mailing Address
First Line	:	11605 N LAMAR BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78753-2658
Country	:	US
Telephone Number	:	737-222-6996
Fax Number	:	512-522-8836

Provider Business Practice Location Address
First Line	:	2525 VIA CAMPO
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-1806
Country	:	US
Telephone Number	:	323-765-2818
Fax Number	:

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

Provider Enumeration Date	:	11/06/2019
Last Update Date	:	11/06/2019

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Directions to “ ODETTE MELENDEZ ” Practice Location

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