Provider Demographics
NPI:1700018520
Name:BALLARD, MELANIE JOAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:JOAN
Last Name:BALLARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:JOAN
Other - Last Name:PELOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 207170
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7170
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:1723 MARION MOUNT GILEAD RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-7842
Practice Address - Country:US
Practice Address - Phone:740-387-6880
Practice Address - Fax:740-387-7433
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5781152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0061799Medicaid
OHH112442Medicare PIN