Provider Demographics
NPI:1871874750
Name:MELENDEZ, JORGE A (OD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:A
Last Name:MELENDEZ
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:PO BOX 270208
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-3008
Mailing Address - Country:US
Mailing Address - Phone:787-374-3925
Mailing Address - Fax:
Practice Address - Street 1:P.R. - 2 KM 42.2
Practice Address - Street 2:BARRIO ALGARROBO
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-374-3925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00634100152W00000X
PR707152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist