Provider Demographics
NPI:1982955274
Name:DUKES, MEL LEN (OPTICAN)
Entity Type:Individual
Prefix:
First Name:MEL
Middle Name:LEN
Last Name:DUKES
Suffix:
Gender:M
Credentials:OPTICAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W EVERLY BROTHERS BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-2708
Mailing Address - Country:US
Mailing Address - Phone:270-399-1983
Mailing Address - Fax:270-754-3354
Practice Address - Street 1:110 W EVERLY BROTHERS BLVD STE G
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-2708
Practice Address - Country:US
Practice Address - Phone:270-399-1983
Practice Address - Fax:270-754-3354
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1095156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician