Provider Demographics
NPI:1700904844
Name:MELENDEZ, CARLOS A (OD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:MELENDEZ
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 1:1787 CALLE CLAVEL
Mailing Address - Street 2:MANSIONES DE RIO PIEDRAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7218
Mailing Address - Country:US
Mailing Address - Phone:787-671-6971
Mailing Address - Fax:
Practice Address - Street 1:22 AVE WINSTON CHURCHILL LOCAL E009
Practice Address - Street 2:SENORIAL PLAZA
Practice Address - City:SAN JUAN, PR
Practice Address - State:PR
Practice Address - Zip Code:00926-6001
Practice Address - Country:US
Practice Address - Phone:787-765-4609
Practice Address - Fax:787-765-4609
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR480152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist