Provider Demographics
NPI:1780744953
Name:JONES, MELANIE JANKOWSKI (OD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:JANKOWSKI
Last Name:JONES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:JANKOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5003 E BONNY BRUCE
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 PIPESTONE RD
Practice Address - Street 2:ORCHARDS MALL
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-2311
Practice Address - Country:US
Practice Address - Phone:269-924-2406
Practice Address - Fax:269-927-2157
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003793152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist