Individual provider Active NPI

Melissa Marie Willey, O.D.

  • Optometrist
  • Carlsbad, CA
National Provider Identifier
1679836928
Registry record updated Jan 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
14415 Issued in CA
Practice address
2628 Gateway Rd Ste 125
Carlsbad, CA 92009-1777
Phone
(760) 237-8777
Fax
(760) 237-8773
NPI assigned
Jun 21, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 14415 CA Primary

Addresses

Primary practice location

2628 Gateway Rd Ste 125
Carlsbad, CA 92009-1777

Mailing address

6418 Kinglet Way
Carlsbad, CA 92011-2700
Phone (760) 525-5421

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131212000005 CA Practitioner - Optometry 6103065701 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2628 Gateway Rd
Suite 125
Carlsbad, CA 92009-1777
Phone (760) 237-8777

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14415CAMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Melissa M Willey OD a Professional Corporation Optometrist CurrentSince Jan 1, 2023 Accepting new patients

Locations

2628 Gateway Rd
Ste 125
Carlsbad, CA 92009
Phone (760) 237-8777

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1340236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673395200000",
    "number": "1679836928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6418 KINGLET WAY",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920112700",
            "telephone_number": "760-525-5421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2628 GATEWAY RD STE 125",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920091777",
            "telephone_number": "760-237-8777",
            "fax_number": "760-237-8773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLEY",
        "first_name": "MELISSA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-21",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carlsbad, CA

Sources for this page

Verify at the official NPI Registry.