Healthcare Provider Details

I. General information

NPI: 1780035584
Provider Name (Legal Business Name): ELAINE MONIQUE RAMOS ROE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 W UTOPIA RD
GLENDALE AZ
85308-5251
US

IV. Provider business mailing address

19389 N 59TH AVE
GLENDALE AZ
85308-6500
US

V. Phone/Fax

Practice location:
  • Phone: 623-806-7200
  • Fax: 623-806-7210
Mailing address:
  • Phone: 623-806-7200
  • Fax: 623-480-6872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number33822
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002404
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberTUV008428-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number33822
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: