=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912902693
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID MICHAEL MELGARY O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2005
-----------------------------------------------------
Last Update Date | 12/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3233 BELMONT ST
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43906-1520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-676-4717
-----------------------------------------------------
Fax | 740-676-4695
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3233 BELMONT ST
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43906-1520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-676-4717
-----------------------------------------------------
Fax | 740-676-4695
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 3515 T782
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | MM0091518
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------