Healthcare Provider Details

I. General information

NPI: 1215998158
Provider Name (Legal Business Name): STANLEY JAMES MONSON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 STEIN BLVD
EAU CLAIRE WI
54701-4499
US

IV. Provider business mailing address

2600 STEIN BLVD
EAU CLAIRE WI
54701-4499
US

V. Phone/Fax

Practice location:
  • Phone: 715-832-4946
  • Fax: 715-832-0699
Mailing address:
  • Phone: 715-832-4946
  • Fax: 715-832-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1355035
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: