Provider Demographics
NPI:1972615722
Name:BROWN-DEMICHELE, MELANIE ANN (OD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:BROWN-DEMICHELE
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 1:200 MIFFLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503
Mailing Address - Country:US
Mailing Address - Phone:570-342-3145
Mailing Address - Fax:570-344-1309
Practice Address - Street 1:2450 MEMORIAL HWY STE 6
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-9285
Practice Address - Country:US
Practice Address - Phone:570-675-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
812005OtherFIRST PRIORITY HEALTH
BR607231OtherHIGH MARK BLUE SHIELD
410043417OtherRAILROAD MEDICARE
PA1803815Medicaid
59623OtherGEISINGER HEALTH PLAN
506554OtherAETNA
506554OtherAETNA
BR607231OtherHIGH MARK BLUE SHIELD