Provider Demographics
NPI:1184623860
Name:ROOT, MONIQUE P (OD)
Entity type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:P
Last Name:ROOT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5901 WESTOWN PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:W DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8218
Mailing Address - Country:US
Mailing Address - Phone:515-225-3546
Mailing Address - Fax:515-224-5946
Practice Address - Street 1:5901 WESTOWN PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:W DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8218
Practice Address - Country:US
Practice Address - Phone:515-225-3546
Practice Address - Fax:515-224-5946
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02237152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0425868Medicaid
IA35721OtherBLUE CROSS BLUE SHIELD
IAP00114822OtherMEDICARE RAILROAD
IAP00114822OtherMEDICARE RAILROAD
IAU21239Medicare UPIN