Provider Demographics
NPI:1770656191
Name:REDMOND, MONICA (OD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:REDMOND
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3685 BURGOYNE AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-1266
Mailing Address - Country:US
Mailing Address - Phone:518-747-4100
Mailing Address - Fax:518-747-6151
Practice Address - Street 1:3685 BURGOYNE AVE
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-2168
Practice Address - Country:US
Practice Address - Phone:518-747-4100
Practice Address - Fax:518-747-6151
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006839-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC369F1OtherEMPIRE
NY10089360OtherCDPHP
NY000408532001OtherBSNENY
NY782077OtherMVP
NY782077OtherMVP
NYC369F1OtherEMPIRE