Provider Demographics
NPI:1346422474
Name:MARCIA J. MONROE,O.D.,INC
Entity Type:Organization
Organization Name:MARCIA J. MONROE,O.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONROE,O.D.,INC
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-522-8777
Mailing Address - Street 1:915 W BROWN ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2715
Mailing Address - Country:US
Mailing Address - Phone:812-522-8777
Mailing Address - Fax:812-524-0042
Practice Address - Street 1:915 W BROWN ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2715
Practice Address - Country:US
Practice Address - Phone:812-522-8777
Practice Address - Fax:812-524-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002155B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200390280AMedicaid
IN193260AOtherMEDICARE
INHO9075OtherARNETT CLARION
IN193260AOtherMEDICARE
IN200390280AMedicaid