Individual
TIMOTHY JAMES MELLUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3700 RIVERTOWN PKWY SW, SPACE 2112 RIVERTOWN CROSSINGS, GRANDVILLE, MI 49418-3085
(616) 249-7362
(616) 249-8097
Mailing address
3700 RIVERTOWN PKWY SW, SPACE 2112 RIVERTOWN CROSSINGS, GRANDVILLE, MI 49418-3085
(616) 249-7362
(616) 249-8097
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002398
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OP27480
GROUP PTAN
MI
Enumeration date
12/12/2006
Last updated
03/10/2010
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