Provider Demographics
NPI:1508856345
Name:MONROE, STEVEN NORMAN (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:NORMAN
Last Name:MONROE
Suffix:
Gender:M
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 376
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-0376
Mailing Address - Country:US
Mailing Address - Phone:952-445-4474
Mailing Address - Fax:952-496-3432
Practice Address - Street 1:312 1ST AVE E
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-1443
Practice Address - Country:US
Practice Address - Phone:952-445-4474
Practice Address - Fax:952-496-3432
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2369152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN111336OtherPATIENT CHOICE
MN45415CHOtherBLUE CROSS BLUE SHIELD
MN51287MOOtherBLUE CROSS BLUE SHIELD
MN2222868Medicaid
MN38369OtherHEALTH PARTNERS
MN962590653003OtherPREFERRED ONE
MN45416EYOtherBLUE CROSS BLUE SHIELD
MN2222869Medicaid
MN2100004Medicaid
MN2114051Medicaid
MN321525300Medicaid
MN38662OtherHEALTH PARTNERS
MN51282MOOtherBLUE CROSS BLUE SHIELD
MN410000699Medicare ID - Type Unspecified
MN2100004Medicaid
MN1113260001Medicare NSC
MN51282MOOtherBLUE CROSS BLUE SHIELD