Individual
DR. GARY J. MELLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
102 E MAIN ST, BOYNE CITY, MI 49712-1336
(231) 582-6704
(231) 582-7113
Mailing address
102 E MAIN ST, BOYNE CITY, MI 49712-1336
(231) 582-6704
(231) 582-7113
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002461
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
86 1862718
—
MI
05
—
94 5024936
—
MI
Enumeration date
01/20/2006
Last updated
09/11/2008
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