MEDICARE: DR. MAX EDWARD MELBERG OD

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	3470-35	WI

General Provider Information

NPI Number	:	1487175766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAX EDWARD MELBERG OD

Provider Business Mailing Address
First Line	:	1029 S PERRY PKWY
Second Line	:
City	:	OREGON
State	:	WI
Zip	:	53575-3450
Country	:	US
Telephone Number	:	715-214-5396
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 W NETHERWOOD ST
Second Line	:
City	:	OREGON
State	:	WI
Zip	:	53575-1100
Country	:	US
Telephone Number	:	608-835-3579
Fax Number	:

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

Provider Enumeration Date	:	06/27/2017
Last Update Date	:	08/24/2023

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