Provider Demographics
NPI:1710538343
Name:MONARCH BAY OPTOMETRY, INC.
Entity Type:Organization
Organization Name:MONARCH BAY OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-962-5868
Mailing Address - Street 1:32932 PACIFIC COAST HWY STE 13
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3467
Mailing Address - Country:US
Mailing Address - Phone:949-487-3937
Mailing Address - Fax:949-487-3913
Practice Address - Street 1:32932 PACIFIC COAST HWY STE 13
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3467
Practice Address - Country:US
Practice Address - Phone:949-487-3937
Practice Address - Fax:949-487-3913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty