Organization
MELISSA J MCCULLEY O D P C
Active
Other names
McCulley Optix Gallery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MELISSA J MCCULLEY O.D. (PRESIDENT)
(701) 373-2020
Entity
Organization
Contact information
Practice address
567 32ND AVE E, WEST FARGO, ND 58078-8480
(701) 373-2020
(701) 373-0021
Mailing address
567 32ND AVE E, WEST FARGO, ND 58078-8480
(701) 373-2020
(701) 373-0021
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ND597
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06711001
BLUE SHIELD GROUP NUMBER
ND
01
—
88G74MC
BLUE SHIELD
MN
Enumeration date
03/22/2007
Last updated
02/09/2023
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