Provider Demographics
NPI:1003176850
Name:MELLINGER, ANNA GREENE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:GREENE
Last Name:MELLINGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4247 LOCUST ST
Mailing Address - Street 2:APT 826
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5252
Mailing Address - Country:US
Mailing Address - Phone:919-417-0863
Mailing Address - Fax:
Practice Address - Street 1:123 E LAUREL RD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1324
Practice Address - Country:US
Practice Address - Phone:856-784-0936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00638300152W00000X
NJ27OA00638301152W00000X
PAOEG002590152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist