Mel Rockwall LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

MEL ROCKWALL LLC

Practice address

1701 E Broad St Ste 109
Mansfield, TX 76063-4349

Phone

(682) 341-3921

Fax

(561) 828-8367

NPI assigned

Dec 9, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jackie Bennett

Title

Credentialing Supervisor

Phone

(561) 433-6009

Specialties & licenses 1

Addresses

Other names 1

• My Eyelab Doing business as

Tax ID family

Mel Rockwall LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mel Rockwall LLC

  • Optometrist
  • Allen, TX
  • NPI 1477190437
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1575849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613692800000",
    "number": "1346887304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1784 W MCDERMOTT DR STE 110",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750133395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 E BROAD ST STE 109",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760634349",
            "telephone_number": "682-341-3921",
            "fax_number": "561-828-8367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEL ROCKWALL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-09",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "561-433-6009"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "My Eyelab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "My Eyelab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Crystal Maureen Meehan
• Gary Wayne Meeks, D.C.
• Renee Mehlmann, LPC
• Leorosa Maria Kennedy Mejia
• Sebastian Mejia
• Melody a. Burton, DO, PA
• Melrose Pharmacy LLC
• Malissa Melton-Otunba, M.A., LPC
• Muhammad Anis Memon, M.D.
• Fannielyn Mendoza

• Eyewear Supplier in Mansfield, TX
• Providers in Mansfield, TX by specialty
• Eyewear Supplier in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.