MEDICARE: DR. CARL BERNARD MELNIK O.D.

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	04723T	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	4953670001	OTHER	CA	MEDICARE CIGNA GROUP NO.

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3641	OTHER	CA	MEDICAL EYE SERVICE INSUR
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871553891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL BERNARD MELNIK O.D.

Provider Business Mailing Address
First Line	:	18013 CHATSWORTH ST
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-5608
Country	:	US
Telephone Number	:	818-366-2020
Fax Number	:	818-366-9868

Provider Business Practice Location Address
First Line	:	18013 CHATSWORTH ST
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-5608
Country	:	US
Telephone Number	:	818-366-2020
Fax Number	:	818-366-6898

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	06/28/2011

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