Provider Demographics
NPI:1699275164
Name:COLLETTA, MEGAN (OD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:
Last Name:COLLETTA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:40820 WINCHESTER RD STE 1360
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5533
Mailing Address - Country:US
Mailing Address - Phone:951-296-0328
Mailing Address - Fax:951-296-0342
Practice Address - Street 1:40820 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5525
Practice Address - Country:US
Practice Address - Phone:951-296-0328
Practice Address - Fax:951-296-0342
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33878TLG152W00000X
CAOPT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist