Provider Demographics
NPI:1922836154
Name:OZGUR, MELANIE MAI-LIEN (OD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:MAI-LIEN
Last Name:OZGUR
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 1:23361 GONDOR DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3725
Mailing Address - Country:US
Mailing Address - Phone:949-769-0972
Mailing Address - Fax:
Practice Address - Street 1:999 N TUSTIN AVE STE 17
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6504
Practice Address - Country:US
Practice Address - Phone:714-972-8432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT35763-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist