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General NPI Number Information
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NPI Number | 1063531408
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Entity Type | Organization
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Legal Business Name | MONROE FAMILY EYECARE, LLC
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 1113 17TH AVE
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City | MONROE
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State | WI
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Zip | 53566-2063
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Country | US
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Telephone | 608-325-5606
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Fax | 608-325-5637
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Provider Business Mailing Address
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Address Line | PO BOX 299
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City | MONROE
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State | WI
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Zip | 53566-0299
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Country | US
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Telephone | 608-325-5606
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Fax | 608-325-5637
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Authorized Official
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Title or Position | OPTOMETRIST OWNER
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Name | DR. JAMES HEALY
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Credential | O.D.
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Telephone | 608-325-5606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 1670
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License Number State | WI
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