Provider Demographics
NPI:1205977733
Name:MONTY, JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MONTY
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 1:5300 S 76TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-1102
Mailing Address - Country:US
Mailing Address - Phone:414-421-9330
Mailing Address - Fax:414-421-3159
Practice Address - Street 1:5300 S 76TH ST
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-1102
Practice Address - Country:US
Practice Address - Phone:414-421-9330
Practice Address - Fax:414-421-3159
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2451-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist