Healthcare Provider Details

I. General information

NPI: 1942186895
Provider Name (Legal Business Name): GENE MONTES LDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 POMELLO AVE SW
PALM BAY FL
32908-4943
US

IV. Provider business mailing address

2906 POMELLO AVE SW
PALM BAY FL
32908-4943
US

V. Phone/Fax

Practice location:
  • Phone: 321-917-5057
  • Fax:
Mailing address:
  • Phone: 321-917-5057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: