Gary J. Mellon, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901002461 Issued in MI

Practice address

102 E Main St
Boyne City, MI 49712-1336

Phone

(231) 582-6704

Fax

(231) 582-7113

NPI assigned

Jan 20, 2006

Sex

Male

Sole proprietor

Yes

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.

• Gary J. Mellon ,O.D.,P.C.

  • Eyewear Supplier
  • Boyne City, MI
  • NPI 1609045921

  Optometrist

  NPD (past) Authorized official
• Gaylord Eye Care Center Inc

  • Optometrist
  • Gaylord, MI
  • NPI 1306827837
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 11, 2008.

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221091200000",
    "number": "1861472268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 E MAIN ST",
            "city": "BOYNE CITY",
            "state": "MI",
            "postal_code": "497121336",
            "telephone_number": "231-582-6704",
            "fax_number": "231-582-7113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 E MAIN ST",
            "city": "BOYNE CITY",
            "state": "MI",
            "postal_code": "497121336",
            "telephone_number": "231-582-6704",
            "fax_number": "231-582-7113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLON",
        "first_name": "GARY",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-20",
        "last_updated": "2008-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901002461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "86 1862718",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "94 5024936",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Max H Engelman
• McLaren Central Michigan
• McLaren Central Michigan
• Tammy Croy McMillian, PH.D., LMSW
• Medical Family Therapy LLC
• Michael a. Fleming D.D.S., P.C.
• Kelly Marie Miller, MA, LPC, NCC
• Syndal Mills, LMSW
• Amy L Mitchell, MD
• John Rex Moriarity, D.D.S.

• All providers in Boyne City, MI
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; 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.