1013029578 NPI number — MELANIE J CARVELL OD

Table of content: MELANIE J CARVELL OD (NPI 1013029578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013029578 NPI number — MELANIE J CARVELL OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARVELL
Provider First Name:
MELANIE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013029578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5921 COLLINS RD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32244-5801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-777-3937
Provider Business Mailing Address Fax Number:
904-777-8208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5921 COLLINS RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32244-5801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-777-3937
Provider Business Practice Location Address Fax Number:
904-777-8208
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPC2265 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 591515138 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 591515138 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 591515138 . This is a "VISION SERVICE PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 19178 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 591515138 . This is a "COMP BENEFITS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 591515138 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33476000 . This is a "DAVISVISION" identifier . This identifiers is of the category "OTHER".




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