=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790897155
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. CARVELL AND ASSOCIATES, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 08/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5921 COLLINS RD SUITE 1
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32244-5801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-777-3937
-----------------------------------------------------
Fax | 904-777-8208
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5921 COLLINS RD SUITE 1
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32244-5801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-777-3937
-----------------------------------------------------
Fax | 904-777-8208
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPTOMETRIST
-----------------------------------------------------
Name | MELANIE J CARVELL
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 904-777-3937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------