Provider Demographics
NPI:1902112477
Name:LANGFORD, MELANIE KLEISER (OD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:KLEISER
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MELANIE
Other - Middle Name:JOANNE
Other - Last Name:KLEISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4310 GENESEE AVE
Mailing Address - Street 2:STE. 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4970
Mailing Address - Country:US
Mailing Address - Phone:858-560-5181
Mailing Address - Fax:
Practice Address - Street 1:4310 GENESEE AVE
Practice Address - Street 2:STE. 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4970
Practice Address - Country:US
Practice Address - Phone:858-560-5181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 14061 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist