Provider Demographics
NPI:1538242102
Name:MONUMENT VISION CLINIC, PC
Entity type:Organization
Organization Name:MONUMENT VISION CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:308-632-2020
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69363-0008
Mailing Address - Country:US
Mailing Address - Phone:308-632-2020
Mailing Address - Fax:
Practice Address - Street 1:1930 E 20TH PL
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-2708
Practice Address - Country:US
Practice Address - Phone:308-632-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEDG8384OtherPALMETTO GBA
NEB0069000OtherFIRST HEALTH
NEB0069000OtherFIRST HEALTH
NE4622170001Medicare NSC
NE099283Medicare PIN