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General NPI Number Information
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NPI Number | 1144400599
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Entity Type | Individual
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Provider Name | MONICA RAE STOTLER O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 05/05/2024
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Provider Practice Location Address
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Address Line | 1727 WILLOW CREEK RD
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City | PRESCOTT
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State | AZ
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Zip | 86301-1154
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Country | US
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Telephone | 928-717-3259
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Fax |
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Provider Business Mailing Address
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Address Line | 1727 WILLOW CREEK RD
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City | PRESCOTT
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State | AZ
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Zip | 86301-1154
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Country | US
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Telephone | 928-717-3259
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Fax |
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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 | 3214ATI
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License Number State | OR
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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 | 1604
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License Number State | AZ
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