Provider Demographics
NPI:1740262088
Name:CLEVELAND, MELVIN G JR (OD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:G
Last Name:CLEVELAND
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3703 W GREEN OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-3328
Mailing Address - Country:US
Mailing Address - Phone:817-496-6022
Mailing Address - Fax:817-496-8911
Practice Address - Street 1:3703 W GREEN OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-3328
Practice Address - Country:US
Practice Address - Phone:817-496-6022
Practice Address - Fax:817-496-8911
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2788TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80648QOtherBLUE CROSS BLUE SHIELD
TXP00747362OtherMEDICARE RAILROAD
TX1216335-01Medicaid
TX80648QOtherBLUE CROSS BLUE SHIELD
TX00E42CMedicare PIN
TX0491770001Medicare NSC
TX0A4688Medicare PIN