Provider Demographics
NPI:1548422645
Name:LADOUCEUR, MONICA R (OD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:R
Last Name:LADOUCEUR
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:P.O. BOX 97876
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85060
Mailing Address - Country:US
Mailing Address - Phone:541-296-2911
Mailing Address - Fax:
Practice Address - Street 1:1010 E MCDOWELL RD
Practice Address - Street 2:STE 301
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2609
Practice Address - Country:US
Practice Address - Phone:602-222-2234
Practice Address - Fax:866-985-7247
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3267ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500664737Medicaid
ORR162444Medicare PIN