Healthcare Provider Details

I. General information

NPI: 1366430860
Provider Name (Legal Business Name): JOHN M. MELNYK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 OLENTANGY RIVER RD
COLUMBUS OH
43212-3153
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8116
  • Fax: 614-293-3555
Mailing address:
  • Phone: 614-293-8116
  • Fax: 614-685-1941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.6056-THER
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: