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General NPI Number Information
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NPI Number | 1174114193
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Entity Type | Organization
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Legal Business Name | MEL VISION LLC
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Dates
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Enumeration Date | 02/02/2021
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 4700 SE 15TH ST
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City | DEL CITY
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State | OK
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Zip | 73115-3966
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Country | US
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Telephone | 561-275-2020
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Fax | 561-828-8367
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Provider Business Mailing Address
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Address Line | 2199 GLENMORE LN
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City | SNELLVILLE
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State | GA
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Zip | 30078-5611
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Country | US
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Telephone | 561-275-2020
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Fax | 561-828-8367
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | JACKIE BENNETT
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Credential |
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Telephone | 505-365-0979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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