Provider Demographics
NPI:1699888495
Name:EVERS, MELVIN CHARLES (OD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:CHARLES
Last Name:EVERS
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 1:910 EMMETT STREET
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741
Mailing Address - Country:US
Mailing Address - Phone:407-846-2277
Mailing Address - Fax:407-846-3922
Practice Address - Street 1:910 EMMETT STREET
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741
Practice Address - Country:US
Practice Address - Phone:407-846-2277
Practice Address - Fax:407-846-3922
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1029152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084612100Medicaid
FL0677750001Medicare NSC
T93824Medicare UPIN
FL19346Medicare ID - Type Unspecified