MEDICARE: CARLOS A. MELENDEZ OD

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
1	152W00000X	Optometrist	480	PR

General Provider Information

NPI Number	:	1700904844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS A. MELENDEZ OD

Provider Business Mailing Address
First Line	:	1787 CALLE CLAVEL
Second Line	:	MANSIONES DE RIO PIEDRAS
City	:	SAN JUAN
State	:	PR
Zip	:	00926-7218
Country	:	US
Telephone Number	:	787-671-6971
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 AVE WINSTON CHURCHILL LOCAL E009
Second Line	:	SENORIAL PLAZA
City	:	SAN JUAN, PR
State	:	PR
Zip	:	00926-6001
Country	:	US
Telephone Number	:	787-765-4609
Fax Number	:	787-765-4609

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	03/20/2024

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