Individual
DR. MELISSA J MCCULLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2553 KIRSTEN LN S # 202, FARGO, ND 58104-4901
(701) 373-2020
(701) 373-0021
Mailing address
2553 KIRSTEN LN S # 202, FARGO, ND 58104-4901
(701) 373-2020
(701) 373-0021
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2824
MN
152W00000X
Optometrist
Primary
ND597
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
026373
BLUE SHIELD
ND
01
—
88G84MC
BLUE SHIELD
MN
Enumeration date
03/22/2007
Last updated
07/08/2007
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