GM Sally Mellgren, M.D. Inc.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

G53485 Issued in CA

Legal business name

GM SALLY MELLGREN, M.D. INC.

Practice address

3621 Vista Way
Oceanside, CA 92056-4522

Phone

(760) 757-1144

Fax

(760) 721-7701

NPI assigned

May 31, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Joanne R Roper

Title

Practice Administrator

Phone

(760) 757-1144

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sarah K. Wood, O.D.

  • Optometrist
  • Ann Arbor, MI
  • NPI 1114941622
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335312000000",
    "number": "1285637637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 VISTA WAY",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920564522",
            "telephone_number": "760-757-1144",
            "fax_number": "760-721-7701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3621 VISTA WAY",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920564522",
            "telephone_number": "760-757-1144",
            "fax_number": "760-721-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GM SALLY MELLGREN, M.D. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-31",
        "last_updated": "2012-04-25",
        "status": "A",
        "authorized_official_last_name": "ROPER",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "760-757-1144",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G53485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G534850",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "33-0241763A",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIFORNIA",
            "identifier": "ZZZ07175Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Judd L. Glasser, M.D.
• Mollie Ann Glasser
• Ashley Nicole Gleason
• Taylor Gleason
• GM Investment Group LLC
• Go2Medical Management Services, Inc.
• Go2Medical, LLC
• Melissa Rachel Godinez, RDHAP
• Emily Godzak
• Nicole Goemann, R.N.

• Ophthalmology Physician in Oceanside, CA
• Providers in Oceanside, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.