Provider Demographics
NPI:1497745384
Name:MELGARY, ADRIENNE (OD)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:MELGARY
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 1:99 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26070-1656
Mailing Address - Country:US
Mailing Address - Phone:304-737-3440
Mailing Address - Fax:304-737-4042
Practice Address - Street 1:99 7TH ST
Practice Address - Street 2:
Practice Address - City:WELLSBURG
Practice Address - State:WV
Practice Address - Zip Code:26070-1656
Practice Address - Country:US
Practice Address - Phone:304-737-3440
Practice Address - Fax:304-737-4042
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV768-OD152W00000X
WVMM0091544152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0150841000Medicaid
T32375Medicare UPIN
WV0150841000Medicaid