Provider Demographics
NPI:1437553336
Name:LAWRENCE, MELANIE (OD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:LAWRENCE
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 1:605 JASMINE TRL
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-3661
Mailing Address - Country:US
Mailing Address - Phone:334-365-2020
Mailing Address - Fax:334-365-4845
Practice Address - Street 1:2020 MARTIN ST S
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35128-2326
Practice Address - Country:US
Practice Address - Phone:058-842-0202
Practice Address - Fax:205-338-8840
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-D30-TA-A06152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist