MEDICARE: ROSEMARY MELROSE 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	7561T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0694800001	OTHER	CA	DMERC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366556870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEMARY MELROSE O.D.

Provider Business Mailing Address
First Line	:	3133 W MARCH LN STE 2020
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-2361
Country	:	US
Telephone Number	:	209-951-0820
Fax Number	:	209-951-2348

Provider Business Practice Location Address
First Line	:	3133 W MARCH LN
Second Line	:	STE. 2020
City	:	STOCKTON
State	:	CA
Zip	:	95219-2361
Country	:	US
Telephone Number	:	209-951-0820
Fax Number	:	209-951-2348

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	03/06/2015

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