Organization
PLASTIC AND RECONSTRUCTIVE EYE SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA LYNN MELDRUM M.D. (OWNER PRESIDENT)
(616) 942-6687
Entity
Organization
Contact information
Practice address
2757 LEONARD ST NE, GRAND RAPIDS, MI 49525-5807
(616) 942-6687
(616) 942-9797
Mailing address
2757 LEONARD ST NE, GRAND RAPIDS, MI 49525-5807
(616) 942-6687
(616) 942-9797
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180D117010
BCBSM
MI
01
—
DC7010
RAILROAD MEDICARE
MI
Enumeration date
06/10/2006
Last updated
06/02/2008
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