1164740148 NPI number — KAREN MONTAS-ROJAS, OD, PA

Table of content: (NPI 1164740148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164740148 NPI number — KAREN MONTAS-ROJAS, OD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAREN MONTAS-ROJAS, OD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MR VISION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164740148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2070 S MILITARY TRL
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33415-6409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-932-0728
Provider Business Mailing Address Fax Number:
561-721-1342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2070 S MILITARY TRL
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33415-6409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-932-0728
Provider Business Practice Location Address Fax Number:
561-721-1342
Provider Enumeration Date:
05/14/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MONTAS-ROJAS
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-968-8462

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPC 4354 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 012852100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104808600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".