Organization
GARY J. MELLON ,O.D.,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY J. MELLON O.D. (OWNER)
(231) 582-6704
Entity
Organization
Contact information
Practice address
102 E MAIN ST, BOYNE CITY, MI 49712-1336
(231) 582-6704
Mailing address
102 E MAIN ST, BOYNE CITY, MI 49712-1336
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7000020361
PRIORITY HEALTH
MI
Enumeration date
02/21/2008
Last updated
02/26/2008
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