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General NPI Number Information
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NPI Number | 1972112985
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Entity Type | Organization
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Legal Business Name | DR. MONVELEA MAKOR, O.D. PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/26/2020
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Last Update Date | 07/26/2020
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Provider Practice Location Address
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Address Line | 9846 MISSION GORGE RD
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City | SANTEE
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State | CA
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Zip | 92071-3834
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Country | US
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Telephone | 619-449-0374
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Fax |
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Provider Business Mailing Address
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Address Line | 3735 SOUTHVIEW DR APT 307
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City | SAN DIEGO
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State | CA
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Zip | 92117-5331
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MONVELEA MAKOR
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Credential | OD
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Telephone | 817-915-0415
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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 |
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License Number State |
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