Provider Demographics
NPI:1073637815
Name:MONROE, MARCIA J (OD)
Entity type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:J
Last Name:MONROE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 W BROWN ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2715
Mailing Address - Country:US
Mailing Address - Phone:812-525-5227
Mailing Address - Fax:812-524-0042
Practice Address - Street 1:915 W BROWN ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2715
Practice Address - Country:US
Practice Address - Phone:812-522-8777
Practice Address - Fax:812-524-0042
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002155B152W00000X, 152WX0102X, 152WP0200X, 152WV0400X
IN18002155A152WC0802X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100232590Medicaid
IN200390280OtherGROUP MEDICAID NUMBER