MEDICARE: SUSAN ROST MONAHAN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4106	MA
2	152W00000X	Optometrist	OPC 4616	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013916949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ROST MONAHAN OD

Provider Business Mailing Address
First Line	:	150 PROFESSIONAL DR STE 300
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-7232
Country	:	US
Telephone Number	:	904-285-8448
Fax Number	:	904-285-3410

Provider Business Practice Location Address
First Line	:	150 PROFESSIONAL DR STE 300
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-7232
Country	:	US
Telephone Number	:	904-285-8448
Fax Number	:	904-285-3410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	01/15/2013

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