Provider Demographics
NPI:1922451962
Name:MONSON EYE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MONSON EYE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-366-3285
Mailing Address - Street 1:2230 N UNIVERSITY PKWY
Mailing Address - Street 2:STE 10A
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1509
Mailing Address - Country:US
Mailing Address - Phone:781-366-3285
Mailing Address - Fax:
Practice Address - Street 1:2230 N UNIVERSITY PKWY
Practice Address - Street 2:STE 10A
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1509
Practice Address - Country:US
Practice Address - Phone:781-366-3285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5585785207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty