Provider Demographics
NPI:1871553891
Name:MELNIK, CARL BERNARD (OD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:BERNARD
Last Name:MELNIK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18013 CHATSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5608
Mailing Address - Country:US
Mailing Address - Phone:818-366-2020
Mailing Address - Fax:818-366-9868
Practice Address - Street 1:18013 CHATSWORTH ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5608
Practice Address - Country:US
Practice Address - Phone:818-366-2020
Practice Address - Fax:818-366-6898
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA04723T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3641OtherMEDICAL EYE SERVICE INSUR
CA4953670001OtherMEDICARE CIGNA GROUP NO.
CASD0047230 9Medicaid
CA4953670001OtherMEDICARE CIGNA GROUP NO.
CAT09752Medicare UPIN