Healthcare Provider Details

I. General information

NPI: 1710538343
Provider Name (Legal Business Name): MONARCH BAY OPTOMETRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32932 PACIFIC COAST HWY STE 13
DANA POINT CA
92629-3467
US

IV. Provider business mailing address

32932 PACIFIC COAST HWY STE 13
DANA POINT CA
92629-3467
US

V. Phone/Fax

Practice location:
  • Phone: 949-487-3937
  • Fax: 949-487-3913
Mailing address:
  • Phone: 949-487-3937
  • Fax: 949-487-3913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: CAROL MOORE
Title or Position: INSURANCE ADMINISTRATOR
Credential:
Phone: 626-962-5868