Provider Demographics
NPI:1013088822
Name:MONROE FAMILY EYECARE ASSOCIATES, LLP
Entity Type:Organization
Organization Name:MONROE FAMILY EYECARE ASSOCIATES, LLP
Other - Org Name:MONROE FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:845-783-1224
Mailing Address - Street 1:91 LAKES RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-2613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:91 LAKES RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-2613
Practice Address - Country:US
Practice Address - Phone:845-783-1224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005741152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEU431Medicare ID - Type Unspecified