Provider Demographics
NPI:1861959967
Name:TADROS, MONICA ALICE (OD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:ALICE
Last Name:TADROS
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 1:24918 ESTANCIA CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-4345
Mailing Address - Country:US
Mailing Address - Phone:954-224-8811
Mailing Address - Fax:
Practice Address - Street 1:11745 W INTERSTATE 10
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1048
Practice Address - Country:US
Practice Address - Phone:830-357-0736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5623152W00000X
TX10444152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist