Provider Demographics
NPI:1609820596
Name:MELENDREZ, MARTIN JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JAMES
Last Name:MELENDREZ
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 1:1103 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5310
Mailing Address - Country:US
Mailing Address - Phone:310-376-8975
Mailing Address - Fax:310-376-4828
Practice Address - Street 1:1103 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5310
Practice Address - Country:US
Practice Address - Phone:310-376-8975
Practice Address - Fax:310-376-4828
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8805T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP8805BOtherPPIN
CAWY162OtherGROUP ID NUMBER
CAU19174Medicare UPIN