Provider Demographics
NPI:1962901355
Name:SCHAEFER, MELITA LYNNETTE (ABOM)
Entity type:Individual
Prefix:
First Name:MELITA
Middle Name:LYNNETTE
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:ABOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 S RESERVE ST STE B
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7677
Mailing Address - Country:US
Mailing Address - Phone:406-552-1299
Mailing Address - Fax:
Practice Address - Street 1:2910 S RESERVE ST STE B
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7677
Practice Address - Country:US
Practice Address - Phone:406-552-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
807452156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
087452OtherAMERICAN BOARD OF OPTICIANRY