Provider Demographics
NPI:1649720970
Name:DAVID MARK MONBECK
Entity type:Organization
Organization Name:DAVID MARK MONBECK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MONBECK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-840-1161
Mailing Address - Street 1:3108 N BOUNDARY BLVD BLDG 926
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33621-5050
Mailing Address - Country:US
Mailing Address - Phone:813-840-1161
Mailing Address - Fax:813-840-1173
Practice Address - Street 1:3108 N BOUNDARY BLVD BLDG 926
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33621-5050
Practice Address - Country:US
Practice Address - Phone:813-840-1161
Practice Address - Fax:813-840-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2913152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU65184Medicare UPIN