Provider Demographics
NPI:1144400599
Name:STOTLER, MONICA RAE (OD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:RAE
Last Name:STOTLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:GAMMILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1727 WILLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1154
Mailing Address - Country:US
Mailing Address - Phone:928-717-3259
Mailing Address - Fax:
Practice Address - Street 1:1727 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1154
Practice Address - Country:US
Practice Address - Phone:928-717-3259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3214ATI152W00000X
AZ1604152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist