MEDICARE: MELISSA PRICKETT 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	4483	OR
2	152W00000X	Optometrist	11286T	TX
3	152W00000X	Optometrist	OPT13413T	CA
4	152W00000X	Optometrist	13413T	CA
5	152W00000X	Optometrist	OPT.0003985	CO

General Provider Information

NPI Number	:	1346423753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA PRICKETT O.D.

Provider Business Mailing Address
First Line	:	23592 VIA PALOMA
Second Line	:
City	:	TRABUCO CANYON
State	:	CA
Zip	:	92679-4123
Country	:	US
Telephone Number	:	949-637-8859
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 JOURNEY STE 103
Second Line	:
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-3372
Country	:	US
Telephone Number	:	949-362-3500
Fax Number	:

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

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	02/13/2026

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