Provider Demographics
NPI:1437381076
Name:BALLARD, MONICA (OD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38663-0388
Mailing Address - Country:US
Mailing Address - Phone:662-837-3696
Mailing Address - Fax:
Practice Address - Street 1:220 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-2054
Practice Address - Country:US
Practice Address - Phone:662-837-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS809152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist