Provider Demographics
NPI:1063531408
Name:MONROE FAMILY EYECARE, LLC
Entity type:Organization
Organization Name:MONROE FAMILY EYECARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HEALY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:608-325-5606
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-0299
Mailing Address - Country:US
Mailing Address - Phone:608-325-5606
Mailing Address - Fax:608-325-5637
Practice Address - Street 1:1113 17TH AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-2063
Practice Address - Country:US
Practice Address - Phone:608-325-5606
Practice Address - Fax:608-325-5637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1670152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5098910001Medicare NSC
WI42055Medicare ID - Type UnspecifiedGROUP NUMBER