Provider Demographics
NPI:1144250895
Name:MELLBLOM, FRANK V (OD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:V
Last Name:MELLBLOM
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 1:8320 E MORROW RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-3061
Mailing Address - Country:US
Mailing Address - Phone:928-772-8633
Mailing Address - Fax:
Practice Address - Street 1:V.A. MEDICAL CENTER NAVAHCS
Practice Address - Street 2:500 N HWY 89
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-445-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY131T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist