Individual
MR. JACK PAUL MELMED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPTOMETRIST
Contact information
Practice address
3329 TWEEDY BLVD, SOUTH GATE, CA 90280-4324
(323) 566-6183
(323) 566-0319
Mailing address
3329 TWEEDY BLVD, SOUTH GATE, CA 90280-4324
(323) 566-6183
(323) 566-0319
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4694
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WY152
MEDICARE PTAN
CA
Enumeration date
11/09/2005
Last updated
08/20/2008
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