Provider Demographics
NPI:1902354459
Name:MELISSA M WILLEY OD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MELISSA M WILLEY OD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-525-5421
Mailing Address - Street 1:6418 KINGLET WAY
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-2700
Mailing Address - Country:US
Mailing Address - Phone:760-525-5421
Mailing Address - Fax:
Practice Address - Street 1:2628 GATEWAY RD STE 125
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-1777
Practice Address - Country:US
Practice Address - Phone:760-237-8777
Practice Address - Fax:760-237-8773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14415152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty