Healthcare Provider Details

I. General information

NPI: 1104842905
Provider Name (Legal Business Name): MELISSA ROBINETTE BALL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 N MCWHORTER ST
LONDON KY
40741-2235
US

IV. Provider business mailing address

356 N MCWHORTER ST
LONDON KY
40741-2235
US

V. Phone/Fax

Practice location:
  • Phone: 606-877-6585
  • Fax: 606-877-9936
Mailing address:
  • Phone: 606-877-6585
  • Fax: 606-877-9936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1337DT
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1337DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: