Active NPI
Melissa Marlene Medlock, O.D.
- Optometrist
- Fort Wayne, IN
National Provider Identifier
1356464705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 18003215A
- Practice address
- 333 E Coliseum Blvd
Fort Wayne, IN 46805-1003 - Phone
- (260) 483-2020
- NPI assigned
- Apr 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 18003215A | IN | Primary |
Addresses
Primary practice location
333 E Coliseum Blvd
Fort Wayne, IN 46805-1003
Mailing address
70 Western Ave
Coldwater, MI 49036-1229
Phone (517) 278-9244
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18003215A | IN | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frey Vision Group of Indiana Inc | Optometrist | Past | Accepting new patients |
| National Vision, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optometrist
- Fort Wayne, IN
- NPI 1699109256
-
- Eyewear Supplier
- Fort Wayne, IN
- NPI 1700932415
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1356464705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "70 WESTERN AVE",
"city": "COLDWATER",
"state": "MI",
"postal_code": "490361229",
"telephone_number": "517-278-9244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 E COLISEUM BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468051003",
"telephone_number": "260-483-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDLOCK",
"first_name": "MELISSA",
"middle_name": "MARLENE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IN",
"license": "18003215A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.