=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952393852
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONICA L OMEY M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2005
-----------------------------------------------------
Last Update Date | 04/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 12TH AVE STE 168
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-3947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-332-6639
-----------------------------------------------------
Fax | 817-332-6643
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 12TH AVE STE 168
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-3947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-332-6639
-----------------------------------------------------
Fax | 817-332-6643
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | J7615
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------