Provider Demographics
NPI:1154499325
Name:JERALD L MONSON JR OD
Entity Type:Organization
Organization Name:JERALD L MONSON JR OD
Other - Org Name:MONSON EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:MONSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:507-451-5300
Mailing Address - Street 1:127 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-2320
Mailing Address - Country:US
Mailing Address - Phone:507-451-5300
Mailing Address - Fax:507-451-5840
Practice Address - Street 1:127 W VINE ST
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-2320
Practice Address - Country:US
Practice Address - Phone:507-451-5300
Practice Address - Fax:507-451-5840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM114345OtherSCHA
MN008073000Medicaid
MN35164MOOtherBCBS OWATONNA
MNDG5411Medicare PIN
FM114345OtherSCHA