Provider Demographics
NPI:1124272661
Name:JANUARY MOENNIG O.D. P.A.
Entity type:Organization
Organization Name:JANUARY MOENNIG O.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANUARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOENNIG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-447-5466
Mailing Address - Street 1:900 N BELCHER RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-2105
Mailing Address - Country:US
Mailing Address - Phone:727-447-5466
Mailing Address - Fax:727-449-0616
Practice Address - Street 1:900 N BELCHER RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2105
Practice Address - Country:US
Practice Address - Phone:727-447-5466
Practice Address - Fax:727-449-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2200332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1194100001Medicare NSC
FLBZ167AMedicare PIN