Provider Demographics
NPI:1023171824
Name:FALEY, MONICA L (OD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:FALEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:L
Other - Last Name:TRUAX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX PH
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503-8000
Mailing Address - Country:US
Mailing Address - Phone:928-674-7001
Mailing Address - Fax:928-674-7707
Practice Address - Street 1:OFF HWY 191 HIGHWAY RD
Practice Address - Street 2:
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503
Practice Address - Country:US
Practice Address - Phone:928-725-9690
Practice Address - Fax:928-725-9699
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI159525Medicare UPIN