Provider Demographics
NPI:1619312386
Name:MELANIE J. BALLARD, O.D., LTD.
Entity Type:Organization
Organization Name:MELANIE J. BALLARD, O.D., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-266-4381
Mailing Address - Street 1:221 CRYSTAL PETAL DR
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-5071
Mailing Address - Country:US
Mailing Address - Phone:614-266-4381
Mailing Address - Fax:614-882-9133
Practice Address - Street 1:113 COMMERCE PARK DR STE A
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-6055
Practice Address - Country:US
Practice Address - Phone:614-882-9131
Practice Address - Fax:614-882-9133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5781152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0093191Medicaid
OH0093191Medicaid
OH6839510001Medicare NSC