Provider Demographics
NPI:1861572885
Name:MANN, MELVIN LEE (OD)
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:LEE
Last Name:MANN
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 1:332 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-4038
Mailing Address - Country:US
Mailing Address - Phone:304-325-8685
Mailing Address - Fax:304-324-0429
Practice Address - Street 1:332 NORTH ST
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-4038
Practice Address - Country:US
Practice Address - Phone:304-325-8685
Practice Address - Fax:304-324-0429
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0690-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist