Healthcare Provider Details

I. General information

NPI: 1497745384
Provider Name (Legal Business Name): ADRIENNE MELGARY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 7TH ST
WELLSBURG WV
26070-1656
US

IV. Provider business mailing address

99 7TH ST
WELLSBURG WV
26070-1656
US

V. Phone/Fax

Practice location:
  • Phone: 304-737-3440
  • Fax: 304-737-4042
Mailing address:
  • Phone: 304-737-3440
  • Fax: 304-737-4042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number768-OD
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberMM0091544
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: