Provider Demographics
NPI:1588669014
Name:GUNN, MELINDA B (OD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:B
Last Name:GUNN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:B
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:302 W 14TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3751
Mailing Address - Country:US
Mailing Address - Phone:812-284-0660
Mailing Address - Fax:812-284-3822
Practice Address - Street 1:302 W 14TH ST
Practice Address - Street 2:STE 100
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3751
Practice Address - Country:US
Practice Address - Phone:812-284-0660
Practice Address - Fax:812-284-3822
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002992A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
351995025OtherHUMANA
IN200246740Medicaid
351995025OtherSAGAMORE
351995025OtherUNITED HEALTHCARE
INP00201953OtherCMS MEDICARE RAILROAD
046922OtherSIHO
0000000352903OtherANTHEM
351995025OtherCIGNA
351995025OtherAETNA
KYP00199316OtherCMS MEDICARE RAILROAD
351995025OtherSAGAMORE
P00201953Medicare UPIN
IN200246740Medicaid