Basic Information
| Provider Information | |||||||||
| NPI: | 1174252761 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHEN | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | Q | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3540 SE 80TH AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972062327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038102659 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1750 MCGILCHRIST ST SE STE 130 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973021691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9713042200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2022 | ||||||||
| LastUpdateDate: | 06/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | ATI4632 | OR | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.