Individual
MISS MELISSA ANNE DACUMOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00003971
WA
152W00000X
Optometrist
OPT-OPT-LIC-815
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011003797
MEDICARE MT
MT
05
—
1005577
—
MT
05
—
2030963
—
WA
01
—
G8885650
MEDICARE WA
WA
01
—
G8893416
MEDICARE WA
WA
Enumeration date
05/13/2006
Last updated
11/19/2020
Update your record
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