=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326162553
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLEAR VUE LASER EYE CENTER INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2007
-----------------------------------------------------
Last Update Date | 05/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7657 LAKE WORTH RD
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-432-4141
-----------------------------------------------------
Fax | 561-432-4166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7657 LAKE WORTH RD
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33467-2534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-432-4141
-----------------------------------------------------
Fax | 561-432-4166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. MONIQUE MICHELLE BARBOUR
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-432-4141
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | ME68835
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------