Provider Demographics
NPI:1972614063
Name:FIKKERT, MELODY KAY (OD)
Entity type:Individual
Prefix:DR
First Name:MELODY
Middle Name:KAY
Last Name:FIKKERT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:KAY
Other - Last Name:PECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:100 E NASA PKWY STE 70
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-5300
Mailing Address - Country:US
Mailing Address - Phone:281-332-0698
Mailing Address - Fax:281-332-6689
Practice Address - Street 1:100 E NASA PKWY STE 70
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-5300
Practice Address - Country:US
Practice Address - Phone:281-332-0698
Practice Address - Fax:281-332-6689
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5242TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10117769OtherDPS
TX10117769OtherDPS
TX10117769OtherDPS