Provider Demographics
NPI:1225185069
Name:DR. DOUGLAS T. MUNROE, AN OPTOMETRIST CORP.
Entity Type:Organization
Organization Name:DR. DOUGLAS T. MUNROE, AN OPTOMETRIST CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:MUNROE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:951-737-3881
Mailing Address - Street 1:464 S. CORONA MALL
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-1418
Mailing Address - Country:US
Mailing Address - Phone:951-737-3881
Mailing Address - Fax:951-737-1530
Practice Address - Street 1:464 S. CORONA MALL
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1418
Practice Address - Country:US
Practice Address - Phone:951-737-3881
Practice Address - Fax:951-737-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6298T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11144OtherINLAND EMPIRE HEALTH PLAN
CA06541OtherMEDICAL EYE SERVICES
CA211433OtherEYE MED VISION CARE
CA46237OtherHEALTH NET HMO
CA48690OtherHEALTH NET PPO
CA6100714Medicaid
CASD00062980Medicare ID - Type Unspecified