=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669523163
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT ALAN MONETTA OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2532 OCEAN AVE
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94132-1614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-239-2544
-----------------------------------------------------
Fax | 415-239-1994
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2532 OCEAN AVE
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94132-1614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-239-2544
-----------------------------------------------------
Fax | 415-239-1994
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 7529T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------