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General NPI Number Information
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NPI Number | 1124083886
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Entity Type | Individual
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Provider Name | LIBERTAD MELENDEZ O.D.
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Gender | Female
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 655 7TH ST 78 MDG/SGPFE
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City | ROBINS AFB
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State | GA
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Zip | 31098-2227
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Country | US
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Telephone | 478-284-9484
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Fax |
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Provider Business Mailing Address
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Address Line | 239 ELLICOTT DR
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City | WARNER ROBINS
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State | GA
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Zip | 31088-3068
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Country | US
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Telephone | 478-284-9484
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 001344
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1806
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License Number State | CO
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