Provider Demographics
NPI:1780035584
Name:ROE, ELAINE MONIQUE RAMOS (OD)
Entity type:Individual
Prefix:DR
First Name:ELAINE MONIQUE
Middle Name:RAMOS
Last Name:ROE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:19389 N 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6500
Mailing Address - Country:US
Mailing Address - Phone:623-806-7200
Mailing Address - Fax:623-480-6872
Practice Address - Street 1:5865 W UTOPIA RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5251
Practice Address - Country:US
Practice Address - Phone:623-806-7200
Practice Address - Fax:623-806-7210
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA33822152WP0200X, 152WV0400X, 152WV0400X
AZOPT-002404152W00000X
NYTUV008428-1152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy