Provider Demographics
NPI:1073674115
Name:WEISS, MELANIE DAWN (OD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:DAWN
Last Name:WEISS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MELANIE
Other - Middle Name:D
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1300 19TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-6799
Mailing Address - Country:US
Mailing Address - Phone:605-882-0808
Mailing Address - Fax:605-882-7078
Practice Address - Street 1:1300 19TH ST NE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-6799
Practice Address - Country:US
Practice Address - Phone:605-882-0808
Practice Address - Fax:605-882-7078
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSDT555152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9201302Medicaid
SD0040755OtherWELLMARK BCBS
SD9213913OtherDAKOTA CARE
SDS40755Medicare PIN
SD4821160001Medicare NSC