Provider Demographics
NPI:1497821235
Name:MONROE VISION AND HEARING CENTER, INC.
Entity Type:Organization
Organization Name:MONROE VISION AND HEARING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDNICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:570-421-2680
Mailing Address - Street 1:1036 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1210
Mailing Address - Country:US
Mailing Address - Phone:570-421-2680
Mailing Address - Fax:570-421-2713
Practice Address - Street 1:1036 NORTH NINTH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360
Practice Address - Country:US
Practice Address - Phone:570-421-2680
Practice Address - Fax:570-421-2713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000650152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA056938Medicare PIN