Provider Demographics
NPI:1669803128
Name:MELTON, TIMOTHY (OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:MELTON
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 1:143 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7203
Mailing Address - Country:US
Mailing Address - Phone:702-944-9446
Mailing Address - Fax:702-940-3348
Practice Address - Street 1:143 S WATER ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7203
Practice Address - Country:US
Practice Address - Phone:702-944-9446
Practice Address - Fax:702-940-3348
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV777152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV108155Medicare UPIN