Provider Demographics
NPI:1447446182
Name:MELTON, DONNA R (OD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:R
Last Name:MELTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12272 S 800 E
Mailing Address - Street 2:STE 100
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9789
Mailing Address - Country:US
Mailing Address - Phone:801-987-8698
Mailing Address - Fax:801-206-3449
Practice Address - Street 1:12272 S 800 E
Practice Address - Street 2:STE 100
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9789
Practice Address - Country:US
Practice Address - Phone:801-987-8698
Practice Address - Fax:801-206-3449
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10411240-9934152W00000X
VA0618000803152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist