Provider Demographics
NPI:1568400075
Name:MELMAN, EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:MELMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LAUREL OAK RD
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3512
Mailing Address - Country:US
Mailing Address - Phone:856-783-1040
Mailing Address - Fax:856-783-6611
Practice Address - Street 1:1001 LAUREL OAK RD
Practice Address - Street 2:SUITE A-1
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3512
Practice Address - Country:US
Practice Address - Phone:856-783-1040
Practice Address - Fax:856-783-6611
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4153152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1168207Medicaid
NJ1168207Medicaid
NJ416754QAWMedicare ID - Type Unspecified