Provider Demographics
NPI:1447255807
Name:METSA, MELANIE (OD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:METSA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3095 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2500
Mailing Address - Country:US
Mailing Address - Phone:716-896-8831
Mailing Address - Fax:716-896-2318
Practice Address - Street 1:227 HIGHLAND PKWY
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14223-1407
Practice Address - Country:US
Practice Address - Phone:716-873-4545
Practice Address - Fax:716-896-2318
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005850152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU65196Medicare UPIN
NYL75581Medicare ID - Type Unspecified