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General NPI Number Information
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NPI Number | 1013916949
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Entity Type | Individual
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Provider Name | SUSAN ROST MONAHAN OD
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Gender | Female
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 01/15/2013
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Provider Practice Location Address
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Address Line | 150 PROFESSIONAL DR STE 300
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-7232
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Country | US
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Telephone | 904-285-8448
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Fax | 904-285-3410
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Provider Business Mailing Address
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Address Line | 150 PROFESSIONAL DR STE 300
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-7232
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Country | US
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Telephone | 904-285-8448
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Fax | 904-285-3410
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4106
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 4616
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License Number State | FL
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