MEDICARE: MELISSA CONTRERAS 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	13951	CA

General Provider Information

NPI Number	:	1376855502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA CONTRERAS O.D.

Provider Business Mailing Address
First Line	:	3916 S BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-1307
Country	:	US
Telephone Number	:	323-234-9137
Fax Number	:	323-235-6203

Provider Business Practice Location Address
First Line	:	3916 S BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-1307
Country	:	US
Telephone Number	:	323-234-9137
Fax Number	:	323-235-6203

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

Provider Enumeration Date	:	07/02/2010
Last Update Date	:	03/22/2018

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