Provider Demographics
NPI:1245349331
Name:HINDERSCHIED, MELISSA MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MARIE
Last Name:HINDERSCHIED
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:410 ASPEN CT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56369
Mailing Address - Country:US
Mailing Address - Phone:320-253-4868
Mailing Address - Fax:
Practice Address - Street 1:1948 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345
Practice Address - Country:US
Practice Address - Phone:320-632-9201
Practice Address - Fax:320-632-9202
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2817152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN513T4HIOtherBCBS
MN2202528OtherMEDICA
U86787Medicare UPIN