Provider Demographics
NPI:1578618690
Name:MONROE OPTICAL, INC.
Entity Type:Organization
Organization Name:MONROE OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:770-267-7824
Mailing Address - Street 1:1311 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-1758
Mailing Address - Country:US
Mailing Address - Phone:770-267-7824
Mailing Address - Fax:770-207-0072
Practice Address - Street 1:1311 W SPRING ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-1758
Practice Address - Country:US
Practice Address - Phone:770-267-7824
Practice Address - Fax:770-207-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO000998156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55594554SAMedicare ID - Type UnspecifiedAETNA-MEDICARE
GA0487240001Medicare ID - Type UnspecifiedPALMETTO GBA