Healthcare Provider Details

I. General information

NPI: 1538242102
Provider Name (Legal Business Name): MONUMENT VISION CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 E 20TH PL SUITE 100
SCOTTSBLUFF NE
69361-2708
US

IV. Provider business mailing address

PO BOX 8
SCOTTSBLUFF NE
69363-0008
US

V. Phone/Fax

Practice location:
  • Phone: 308-632-2020
  • Fax:
Mailing address:
  • Phone: 308-632-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JILL A SCHNEIDER
Title or Position: OWNER
Credential: OD
Phone: 308-632-2020