Provider Demographics
NPI:1740001312
Name:MELTON, ROBERT (LDO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MELTON
Suffix:
Gender:U
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 STATE ROAD 436 STE 101
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-6447
Mailing Address - Country:US
Mailing Address - Phone:407-677-7813
Mailing Address - Fax:407-677-9364
Practice Address - Street 1:1239 STATE ROAD 436 STE 101
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-6447
Practice Address - Country:US
Practice Address - Phone:407-677-7813
Practice Address - Fax:407-677-9364
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO5170156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician