Provider Demographics
NPI:1659407989
Name:KERBY, MELISSA SUE (OD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:SUE
Last Name:KERBY
Suffix:
Gender:F
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:PO BOX 263
Mailing Address - Street 2:1001 MONROE ROAD
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-0263
Mailing Address - Country:US
Mailing Address - Phone:513-934-2020
Mailing Address - Fax:513-934-2028
Practice Address - Street 1:1001 MONROE RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1414
Practice Address - Country:US
Practice Address - Phone:513-934-2020
Practice Address - Fax:513-934-2028
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4755152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5574OtherHUMANA
OH0005995677OtherAETNA
OH020765OtherANTHEM
OH2053405Medicaid
OHKE0844961Medicare ID - Type Unspecified
OH2053405Medicaid