Provider Demographics
NPI:1356908115
Name:VIETH, MONICA (OD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:VIETH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:VIETH MUNOZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7077 NORMANDY BLVD STE 7
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-6294
Practice Address - Country:US
Practice Address - Phone:904-781-7717
Practice Address - Fax:904-781-6367
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5642152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist