Provider Demographics
NPI:1740596501
Name:EMMONS, MONIQUE ALISHA (OD)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:ALISHA
Last Name:EMMONS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:A
Other - Last Name:EMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:2634 MEDICAL CENTER PKWY STE C
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-4474
Practice Address - Country:US
Practice Address - Phone:616-344-2157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010390152W00000X
TN2968152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist