Provider Demographics
NPI:1679546261
Name:MONSON, JERALD L JR (OD)
Entity Type:Individual
Prefix:DR
First Name:JERALD
Middle Name:L
Last Name:MONSON
Suffix:JR
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 1:127 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-2320
Mailing Address - Country:US
Mailing Address - Phone:507-451-5300
Mailing Address - Fax:507-451-5840
Practice Address - Street 1:127 W VINE ST
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-2320
Practice Address - Country:US
Practice Address - Phone:507-451-5300
Practice Address - Fax:507-451-5840
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLD1955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN114347OtherSOUTH COUNTRY HEALTH ALLI
MN30554MOOtherBCBS OWATONNA
MN30555MOOtherBCBS WASECA
MN30555MOOtherBCBS WASECA