Provider Demographics
NPI:1194710749
Name:MONROE, DAVID JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:MONROE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 OVERBROOK TER
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15239-1079
Mailing Address - Country:US
Mailing Address - Phone:412-793-2114
Mailing Address - Fax:
Practice Address - Street 1:214 CORBET ST
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084-1815
Practice Address - Country:US
Practice Address - Phone:724-224-8806
Practice Address - Fax:724-224-0828
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA160594OtherCOLE MANAGED VISION
PA001720839Medicaid
PA121934OtherHEALTHASSURANCE/HEALTHAME
PA78019OtherAETNA/USHEALTHCARE
PA565232OtherBLUE CROSS/BLUE SHIELD
PA308997OtherUPMC
PA121934OtherHEALTHASSURANCE/HEALTHAME
PAT87953Medicare UPIN