Provider Demographics
NPI:1215959390
Name:GROFF, MONIKA H (OD)
Entity type:Individual
Prefix:
First Name:MONIKA
Middle Name:H
Last Name:GROFF
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:PO BOX 369
Mailing Address - Street 2:121 SOUTH TAN ALLEY
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17026-0369
Mailing Address - Country:US
Mailing Address - Phone:717-273-1227
Mailing Address - Fax:
Practice Address - Street 1:121 S TAN ALY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:PA
Practice Address - Zip Code:17026-9349
Practice Address - Country:US
Practice Address - Phone:717-865-7225
Practice Address - Fax:717-865-3154
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000859152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA066141000OtherNSC#
PA40540OtherDAVIS VISION
PAFR1392866OtherBLUE SHIELD (PENNVISION)
PAT72780Medicare UPIN
PA066141000OtherNSC#
PA416939QNNMedicare PIN