Healthcare Provider Details

I. General information

NPI: 1447446182
Provider Name (Legal Business Name): DONNA R MELTON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14263 S SCHOOL HOUSE CIR
HERRIMAN UT
84096-3471
US

IV. Provider business mailing address

PSC 477 BOX 578
FPO AP
96306-0006
US

V. Phone/Fax

Practice location:
  • Phone: 703-853-7735
  • Fax:
Mailing address:
  • Phone: 703-853-7735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000803
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10411240-9934
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: