Provider Demographics
NPI:1326020769
Name:MONJE, THOMAS L (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:MONJE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:622 GRAVOIS RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-4137
Mailing Address - Country:US
Mailing Address - Phone:636-343-6664
Mailing Address - Fax:636-326-1616
Practice Address - Street 1:622 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-4137
Practice Address - Country:US
Practice Address - Phone:636-343-6664
Practice Address - Fax:636-326-1616
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02138152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T42601Medicare UPIN
MO0538360001Medicare NSC