Provider Demographics
NPI:1912160540
Name:HJELDEN, MELISSA PHYLLIS (OD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:PHYLLIS
Last Name:HJELDEN
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:PHYLLIS
Other - Last Name:SAMUELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1005 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATFORD CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58854
Mailing Address - Country:US
Mailing Address - Phone:701-444-3221
Mailing Address - Fax:701-401-2448
Practice Address - Street 1:1005 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:WATFORD CITY
Practice Address - State:ND
Practice Address - Zip Code:58854
Practice Address - Country:US
Practice Address - Phone:701-444-3221
Practice Address - Fax:701-401-2448
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3131152W00000X
MT1933152W00000X
ND706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDMS1818434OtherDEA
NDMS1818434OtherDEA
NDN719287Medicare PIN