Provider Demographics
NPI:1477754489
Name:MONARCH, DIANE (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:MONARCH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:MONARCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1101 N MAIN ST STE 304
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-7383
Mailing Address - Country:US
Mailing Address - Phone:843-821-3121
Mailing Address - Fax:
Practice Address - Street 1:1101 N MAIN ST STE 304
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-7383
Practice Address - Country:US
Practice Address - Phone:843-821-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1449152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCA142Medicare PIN