Provider Demographics
NPI:1922188960
Name:CHANEY, MELANIE (OD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:CHANEY
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 1:2806 TREE CROSSINGS PKWY
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4072
Mailing Address - Country:US
Mailing Address - Phone:440-290-9362
Mailing Address - Fax:
Practice Address - Street 1:2000 RIVERCHASE GALLERIA
Practice Address - Street 2:SUITE 299D
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2341
Practice Address - Country:US
Practice Address - Phone:205-985-7612
Practice Address - Fax:205-985-5405
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4730152W00000X
ALR-238-TA-A10152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH611420575054OtherCARESOURCE
OHCH4129273Medicare PIN
OH611420575054OtherCARESOURCE