Provider Demographics
NPI:1649434572
Name:MELAMED, FOUAD (OD)
Entity type:Individual
Prefix:DR
First Name:FOUAD
Middle Name:
Last Name:MELAMED
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 1:8213 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4505
Mailing Address - Country:US
Mailing Address - Phone:323-655-6582
Mailing Address - Fax:
Practice Address - Street 1:8213 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4505
Practice Address - Country:US
Practice Address - Phone:323-655-6582
Practice Address - Fax:323-655-6473
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13527152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAQ318TMedicare PIN