Provider Demographics
NPI:1972572766
Name:MELLING, SCOTT R (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:MELLING
Suffix:
Gender:M
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:CMR 470 BOX 4871
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09165
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HANAU HEALTH CLINIC ATTN: OPTOMETRY
Practice Address - Street 2:UNIT 20193 BOX 0030
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09165
Practice Address - Country:DE
Practice Address - Phone:06181-500-6605
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOD-988152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist