Provider Demographics
NPI:1720008535
Name:MELTON, JENET A (OD)
Entity Type:Individual
Prefix:
First Name:JENET
Middle Name:A
Last Name:MELTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 PARTRIDGE PL STES 9 AND 10
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-0518
Mailing Address - Country:US
Mailing Address - Phone:406-449-3937
Mailing Address - Fax:406-449-3937
Practice Address - Street 1:1040 PARTRIDGE PL STES 9 AND 10
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-0517
Practice Address - Country:US
Practice Address - Phone:406-449-3937
Practice Address - Fax:406-449-3937
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT604152W00000X, 152WL0500X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT048-1678Medicaid
MT048-1678Medicaid
MT3893690001Medicare NSC
U58577Medicare UPIN