Provider Demographics
NPI:1104842905
Name:BALL, MELISSA ROBINETTE (OD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ROBINETTE
Last Name:BALL
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 1:356 N MCWHORTER ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-2235
Mailing Address - Country:US
Mailing Address - Phone:606-877-6585
Mailing Address - Fax:606-877-9936
Practice Address - Street 1:356 N MCWHORTER ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2235
Practice Address - Country:US
Practice Address - Phone:606-877-6585
Practice Address - Fax:606-877-9936
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1337DT152W00000X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100004960OtherEPSDT
KY77013373Medicaid
KY77013373Medicaid
KY1843901Medicare PIN