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NPI Code Detail

MEDICARE: MR. JACK PAUL MELMED OPTOMETRIST

MEDICARE: MR. JACK PAUL MELMED OPTOMETRIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist4694CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1WY152OTHERCAMEDICARE PTAN

General Provider Information

NPI Number : 1518948223
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JACK PAUL MELMED OPTOMETRIST
Provider Business Mailing Address
First Line : 3329 TWEEDY BLVD
Second Line :
City : SOUTH GATE
State : CA
Zip : 90280-4324
Country : US
Telephone Number : 323-566-6183
Fax Number : 323-566-0319
Provider Business Practice Location Address
First Line : 3329 TWEEDY BLVD
Second Line :
City : SOUTH GATE
State : CA
Zip : 90280-4324
Country : US
Telephone Number : 323-566-6183
Fax Number : 323-566-0319
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2005
Last Update Date : 08/20/2008

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