Basic Information
| Provider Information | |||||||||
| NPI: | 1760507164 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR. JAMES W. MOENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 750426 | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454750426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373121106 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8973 KINGSRIDGE DR | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454581623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374350315 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MOENTER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9373121106 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 3259 T1408 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.