Provider Demographics
NPI:1841542719
Name:MELENDEZ, JACQUELINE Y (OD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:Y
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4246 CARR 2
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-4128
Mailing Address - Country:US
Mailing Address - Phone:787-369-6591
Mailing Address - Fax:787-369-0711
Practice Address - Street 1:4246 STREET #2 KM 43.0
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-0069
Practice Address - Country:US
Practice Address - Phone:787-369-6591
Practice Address - Fax:873-690-7117
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00639900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist