Provider Demographics
NPI:1497878508
Name:MELODY F. VEGA
Entity type:Organization
Organization Name:MELODY F. VEGA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:F
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-257-1660
Mailing Address - Street 1:605 E IMPERIAL HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5627
Mailing Address - Country:US
Mailing Address - Phone:714-257-1660
Mailing Address - Fax:714-257-1662
Practice Address - Street 1:605 E IMPERIAL HWY
Practice Address - Street 2:SUITE C
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5627
Practice Address - Country:US
Practice Address - Phone:714-257-1660
Practice Address - Fax:714-257-1662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12660 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID#