DR. GRACE M SALLY MELLGREN (NPI# 1184709339) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184709339 |
| Entity Type | Individual |
| Full Name | DR. GRACE M SALLY MELLGREN |
| Credential | M.D. |
| Practice Address |
342 Sherrill Ln Roswell NM 88201-5819 |
| Practice Telephone | 5756250123 |
| Practice Fax Number | 7607217701 |
| Mailing Telephone | 5756250123 |
| Mailing Fax Number | 7607217701 |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2019-07-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207W00000X | Ophthalmology | G53485 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | BLUE SHIELD OF CA | ZZZ07175Z | 01 |
| CA | 00G53480 | 05 |
| Street Address |
342 SHERRILL LN |
| City | ROSWELL |
| State | NM |
| Zip Code | 88201-5819 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902310022 | Corey A Carter | Specialist/Technologist, Other | 117 E 19th Street, Roswell, NM 88201 | 2017-11-28 |
| 1326598541 | Dove Medical Corporation | Family Medicine | 110 East 3rd Street, Roswell, NM 88201 | 2016-10-12 |
| 1841748381 | Anali Velez | Registered Nurse | 300 N Kentucky, Roswell, NM 88201 | 2016-09-13 |
| 1831647379 | Rebecca Palomino | Registered Nurse | 800 Marion Richards Rd, Roswell, NM 88201 | 2016-09-13 |
| 1215300926 | Heart Path Oriental Medicine | Clinic/Center | 810 N Union, Roswell, NM 88201 | 2015-11-03 |
| 1538564745 | Lacey Scott | Pharmacist | 1835 N. Main, Roswell, NM 88201 | 2014-10-30 |
| 1962815852 | Marium Khan | Internal Medicine | 400 Military Heights Place, Roswell, NM 88201 | 2014-06-09 |
| 1316288913 | Anaya Counseling | Community/Behavioral Health | 613 W 2nd St Ste 4, Roswell, NM 88201 | 2013-03-06 |
| 1205185386 | Rosarita Brady | Occupational Therapist | 300 N. Kentucky, Roswell, NM 88201 | 2012-09-05 |
| 1922360049 | Ashley Spinhirne Thompson | Speech-Language Pathologist | 304 N. Richardson, Roswell, NM 88201 | 2012-06-14 |
| Find all providers in zip 88201 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548657430 | Hannah Park | Ophthalmology | 2500 Hospital Blvd Ste 115, Roswell, GA 30076-4946 | 2015-04-19 |
| 1922373349 | Stephen W. Montgomery, Md, Pa | Ophthalmology | 101 N Missouri Ave, Roswell, NM 88203-4657 | 2012-03-19 |
| 1467601146 | Georgia Ophthalmology Referral Center, LLC | Ophthalmology | 10775 Alpharetta Hwy, Roswell, GA 30076-1772 | 2008-09-17 |
| 1760519227 | Stephen W Montgomery | Ophthalmology | 101 N Missouri Avenue, Roswell, NM 88203-4657 | 2007-02-28 |
| 1205998788 | Richard J Sidd | Ophthalmology | 207 N Union Ave Ste C, Roswell, NM 88201-3068 | 2006-12-14 |
| 1831143502 | Wayne A Delamater | Ophthalmology | 1606 S.e. Main St, Roswell, NM 88203 | 2006-05-19 |
| 1003884602 | Paul F Engstrom | Ophthalmology | 204 W 2nd St, Ste 1, Roswell, NM 88201-4669 | 2006-03-09 |
| 1750388245 | Larry E Heit | Ophthalmology | 11690 Alpharetta Hwy, Roswell, GA 30076-3805 | 2005-06-30 |
| 1396748513 | Susanne Michele Hewitt | Ophthalmology | 2500 Hospital Blvd, Suite 115, Roswell, GA 30076-4907 | 2005-05-23 |
| 1174888267 | Parvathi Rayudu | Ophthalmology | 2500 Hospital Blvd, Suite 115, Roswell, GA 30076-4907 | 2012-07-05 |
| Find all providers in ROSWELL | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.