Healthcare Provider Details

I. General information

NPI: 1912902693
Provider Name (Legal Business Name): DAVID MICHAEL MELGARY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3233 BELMONT ST
BELLAIRE OH
43906-1520
US

IV. Provider business mailing address

3233 BELMONT ST
BELLAIRE OH
43906-1520
US

V. Phone/Fax

Practice location:
  • Phone: 740-676-4717
  • Fax: 740-676-4695
Mailing address:
  • Phone: 740-676-4717
  • Fax: 740-676-4695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3515 T782
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberMM0091518
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: