Provider Demographics
NPI:1013029578
Name:CARVELL, MELANIE J (OD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:J
Last Name:CARVELL
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 1:5921 COLLINS RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5801
Mailing Address - Country:US
Mailing Address - Phone:904-777-3937
Mailing Address - Fax:904-777-8208
Practice Address - Street 1:5921 COLLINS RD
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-5801
Practice Address - Country:US
Practice Address - Phone:904-777-3937
Practice Address - Fax:904-777-8208
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2265152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
591515138OtherAETNA
591515138OtherTRICARE
591515138OtherVISION SERVICE PLAN
19178OtherBLUE CROSS BLUE SHIELD
591515138OtherCOMP BENEFITS
591515138OtherCIGNA
33476000OtherDAVISVISION
U09670Medicare UPIN
FL0418660001Medicare NSC
FL19114ZMedicare PIN