MEDICARE: DR. JOHN MONTY OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2451-035	WI

General Provider Information

NPI Number	:	1205977733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MONTY OD

Provider Business Mailing Address
First Line	:	5300 S 76TH ST
Second Line	:
City	:	GREENDALE
State	:	WI
Zip	:	53129-1102
Country	:	US
Telephone Number	:	414-421-9330
Fax Number	:	414-421-3159

Provider Business Practice Location Address
First Line	:	5300 S 76TH ST
Second Line	:
City	:	GREENDALE
State	:	WI
Zip	:	53129-1102
Country	:	US
Telephone Number	:	414-421-9330
Fax Number	:	414-421-3159

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. JOHN MONTY OD” Practice Location

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