Individual
DR. DEREK MELLOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
8277 MARKET ST, SUITE B, BOARDMAN, OH 44512-6246
(330) 726-5544
(330) 758-3874
Mailing address
8277 MARKET ST, SUITE B, BOARDMAN, OH 44512-6255
(330) 726-5544
(330) 758-3874
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3951
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000226430
ANTHEM BC/BS
OH
05
—
0691381
—
OH
01
—
2201047
UNITED HEALTH CARE
OH
01
—
341605571028
CARESOURCE
OH
01
—
410035075
RAILROAD MEDICARE
OH
Enumeration date
07/20/2006
Last updated
12/28/2007
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