Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 18002155B | IN |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 18002155A | IN |
N | 152WP0200X | Pediatric Optomitrist | 18002155B | IN |
N | 152WS0006X | Sports Vision | 18002155A | IN |
N | 152WV0400X | Optomitrist - Vision Therapist | 18002155B | IN |
N | 152WX0102X | Occupational Vision | 18002155B | IN |
NPI | 1073637815 |
---|---|
Provider Name | Dr. Marcia J Monroe |
First Address | Seymour, IN 47274-2715 |
Second Address | Seymour, IN 47274-2715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100232590 | (05) | IN |
200390280 | GROUP MEDICAID NUMBER (01) | IN |
T88597 | (02) | IN |