Provider Demographics
NPI:1770575508
Name:ELGART, MONYA D (OD)
Entity type:Individual
Prefix:DR
First Name:MONYA
Middle Name:D
Last Name:ELGART
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-4405
Mailing Address - Country:US
Mailing Address - Phone:860-388-2020
Mailing Address - Fax:860-388-0889
Practice Address - Street 1:1156 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-4405
Practice Address - Country:US
Practice Address - Phone:860-388-2020
Practice Address - Fax:860-388-0889
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2455152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004188175Medicaid
U67528Medicare UPIN
CTC00403Medicare PIN
CT410000834Medicare ID - Type Unspecified