Melanie M Chiesa, O.D.
Individual provider Active NPI Optometrist · Turlock, CA
NPI 1760466148 · NPPES record last updated Sep 19, 2011
Key facts
- NPI
- 1760466148
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 10303T (CA)
- Practice address
- 991 E Monte Vista Ave
Turlock, CA 95382-0403 - Phone
- (209) 634-8591
- Fax
- (209) 634-8596
- NPI assigned
- Nov 30, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040603000587 | CA | Practitioner - Optometry | 2961484951 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10303T | CA | MD | Optometrist |
| 10303 | CA | MD | Acupuncturist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fifth Optometric Care of California | Optometrist | Current | Accepting new patients |
| Fifth Optometric Care of California | Optometrist | Current |
Accepting new patients |
| Fifth Optometric Care of California | Optometrist | Current |
Accepting new patients |
Locations
3333 Quality Dr
Rncho Cordova, CA 95670
Phone (704) 712-0564
991 E Monte Vista Ave
Turlock, CA 95382
Phone (209) 634-8591
991 E Monte Vista Ave
Ste 1
Turlock, CA 95382
Phone (209) 634-8591
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 10303T | CA | Yes |
Addresses
Primary practice location
991 E Monte Vista Ave
Turlock, CA 95382-0403
Mailing address
991 E Monte Vista Ave
Turlock, CA 95382-0403
Phone (209) 634-8591
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DB428A | Other | CA | MEDICARE GROUP PTAN |
| 5033839 | Medicaid | CA |
Other providers in Turlock, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.