Provider Demographics
NPI:1336493436
Name:ACOSTA, MONICA (LDO)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13691 METRO PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4327
Mailing Address - Country:US
Mailing Address - Phone:239-334-2105
Mailing Address - Fax:239-936-0047
Practice Address - Street 1:13691 METRO PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4327
Practice Address - Country:US
Practice Address - Phone:239-334-2105
Practice Address - Fax:239-936-0047
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 6378156FC0801X, 156FX1800X
156FX1101X, 156FX1700X, 156FX1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
No156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic Assistant
No156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
No156FX1900XEye and Vision Services ProvidersTechnician/TechnologistOrthoptist