MEDICARE: JILL MONCLA

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	2824	NC

General Provider Information

NPI Number	:	1306665013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL MONCLA

Provider Business Mailing Address
First Line	:	1813 W EHRINGHAUS ST
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-4555
Country	:	US
Telephone Number	:	252-333-1796
Fax Number	:

Provider Business Practice Location Address
First Line	:	1813 W EHRINGHAUS ST
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-4555
Country	:	US
Telephone Number	:	252-333-1155
Fax Number	:	252-333-1796

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

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	04/02/2025

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Directions to “ JILL MONCLA ” Practice Location

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