Provider Demographics
NPI:1346327137
Name:ADAMS-DEROUEN, MONIQUE LASHEA (OD)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:LASHEA
Last Name:ADAMS-DEROUEN
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 1:8765 SPRING CYPRESS RD
Mailing Address - Street 2:SUITE N
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3194
Mailing Address - Country:US
Mailing Address - Phone:281-655-9595
Mailing Address - Fax:281-251-5362
Practice Address - Street 1:8765 SPRING CYPRESS RD
Practice Address - Street 2:SUITE N
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3194
Practice Address - Country:US
Practice Address - Phone:281-655-9595
Practice Address - Fax:281-251-5362
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5113TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU56559Medicare UPIN
TX8A9996Medicare ID - Type Unspecified