Individual
PAUL R MELICHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
100 4TH ST S STE 612, FARGO, ND 58103-1940
(701) 235-0561
(701) 235-0330
Mailing address
100 4TH ST S STE 612, FARGO, ND 58103-1940
(701) 235-0561
(701) 235-0330
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
428
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11481
BLUE SHIELD
ND
01
—
2M311ME
BLUE SHIELD
MN
05
—
60346
—
ND
01
—
800428
VISION SERVICES
ND
Enumeration date
10/11/2006
Last updated
12/12/2007
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