Provider Demographics
NPI:1841479300
Name:MONROE VISION CLINIC, INC
Entity type:Organization
Organization Name:MONROE VISION CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANTON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SESSIONS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-794-2020
Mailing Address - Street 1:14841 179TH AVE SE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1127
Mailing Address - Country:US
Mailing Address - Phone:360-794-2020
Mailing Address - Fax:360-794-7631
Practice Address - Street 1:14841 179TH AVE SE
Practice Address - Street 2:SUITE 110
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1127
Practice Address - Country:US
Practice Address - Phone:360-794-2020
Practice Address - Fax:360-794-7631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3348TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADA9374OtherPALMETTO GBA
WAGAB29964Medicare PIN
WA4611610001Medicare NSC