MEDICARE: MELISSA JANE OGDEN 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	0618002776	VA

General Provider Information

NPI Number	:	1821657016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA JANE OGDEN OD

Provider Business Mailing Address
First Line	:	4018 CAMPBELL AVE
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-3424
Country	:	US
Telephone Number	:	703-671-1188
Fax Number	:

Provider Business Practice Location Address
First Line	:	4018 CAMPBELL AVE
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-3424
Country	:	US
Telephone Number	:	703-671-1188
Fax Number	:

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

Provider Enumeration Date	:	06/11/2019
Last Update Date	:	08/07/2019

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