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General NPI Number Information
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NPI Number | 1720436892
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Entity Type | Individual
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Provider Name | MONICA SZALAJKO O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 2101 FORT HENRY DR SPACE E-9
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City | KINGSPORT
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State | TN
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Zip | 37664-3658
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Country | US
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Telephone | 423-246-1585
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Fax |
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Provider Business Mailing Address
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Address Line | 57199 PONDEROSA CT
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City | SOUTH BEND
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State | IN
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Zip | 46619-5565
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Country | US
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Telephone | 574-807-4588
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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 | 0618002490
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License Number State | VA
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