Provider Demographics
NPI:1952032971
Name:MUNOZ, JOEL (OD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:MUNOZ
Suffix:
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 1:6028 S 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:IL
Mailing Address - Zip Code:60501-1523
Mailing Address - Country:US
Mailing Address - Phone:708-691-4385
Mailing Address - Fax:
Practice Address - Street 1:360 SIERRA COLLEGE DR STE 100
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5088
Practice Address - Country:US
Practice Address - Phone:530-273-3190
Practice Address - Fax:530-273-5541
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty