Provider Demographics
NPI:1811952799
Name:MONSON, ROLAND K (OD)
Entity type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:K
Last Name:MONSON
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 1:2230 N UNIVERSITY PKWY
Mailing Address - Street 2:BUILDING 10A
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1509
Mailing Address - Country:US
Mailing Address - Phone:801-373-4550
Mailing Address - Fax:801-373-8634
Practice Address - Street 1:2230 N UNIVERSITY PKWY
Practice Address - Street 2:BUILDING 10A
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1509
Practice Address - Country:US
Practice Address - Phone:801-373-4550
Practice Address - Fax:801-373-8634
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT109118-9934152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTT78153Medicare UPIN
UT9358Medicare ID - Type Unspecified