Provider Demographics
NPI:1861505315
Name:MAUREY, MELANIE LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:LYNN
Last Name:MAUREY
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 1:1432 N COUNTY ROAD 175 W
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-9294
Mailing Address - Country:US
Mailing Address - Phone:765-653-1987
Mailing Address - Fax:765-655-1278
Practice Address - Street 1:1750 EAST INDIANAPOLIS ROAD
Practice Address - Street 2:WAL-MART VISION CENTER
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135
Practice Address - Country:US
Practice Address - Phone:765-655-1759
Practice Address - Fax:765-655-1278
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002943A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN18002943BOtherLEGEND DRUG CERTIFICATE
IN18002943AOtherLICENSE NUMBER