Provider Demographics
NPI:1518975226
Name:MELLOR, JEFFERY LOVELL (OD, MED)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:LOVELL
Last Name:MELLOR
Suffix:
Gender:M
Credentials:OD, MED
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Mailing Address - Street 1:15037 WINGED BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5719
Mailing Address - Country:US
Mailing Address - Phone:801-649-3692
Mailing Address - Fax:
Practice Address - Street 1:10412 S 2200 W
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8333
Practice Address - Country:US
Practice Address - Phone:801-858-2020
Practice Address - Fax:801-610-2138
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT328094-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist