Provider Demographics
NPI:1932890936
Name:MONROE, EVAN JOHN
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:JOHN
Last Name:MONROE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5991 S GOLDENROD RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8775
Mailing Address - Country:US
Mailing Address - Phone:407-382-8909
Mailing Address - Fax:407-382-8107
Practice Address - Street 1:5991 S GOLDENROD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8775
Practice Address - Country:US
Practice Address - Phone:407-382-8909
Practice Address - Fax:407-382-8107
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO7021156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician