Provider Demographics
NPI:1720436892
Name:SZALAJKO, MONICA (OD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:SZALAJKO
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 1:57199 PONDEROSA CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46619-5565
Mailing Address - Country:US
Mailing Address - Phone:574-807-4588
Mailing Address - Fax:
Practice Address - Street 1:2101 FORT HENRY DR
Practice Address - Street 2:SPACE E-9
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-3658
Practice Address - Country:US
Practice Address - Phone:423-246-1585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002490152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist