Provider Demographics
NPI:1275751216
Name:MELANCON, TRICHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:TRICHELLE
Middle Name:
Last Name:MELANCON
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:PO BOX 90752
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70509-0752
Mailing Address - Country:US
Mailing Address - Phone:254-666-1960
Mailing Address - Fax:
Practice Address - Street 1:1629 CRESWELL LN EXT
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-7815
Practice Address - Country:US
Practice Address - Phone:254-666-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1327-461T152W00000X
TX6018T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty