Individual provider Active NPI

Michael Mark Monson, O.D.

  • Optometrist
  • Heber City, UT
National Provider Identifier
1205927175
Registry record updated May 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
12983357-9934 Issued in UT
Practice address
345 W 600 S Ste 300
Heber City, UT 84032-2268
Phone
(435) 654-1863
NPI assigned
Sep 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 757 OPT MT
Optometrist 152W00000X 12983357-9934 UT Primary

Addresses

Primary practice location

345 W 600 S Ste 300
Heber City, UT 84032-2268

Mailing address

30 S 1970 E
Heber City, UT 84032-4420
Phone (406) 565-8298

Other practice location 1

6584 Creekside Dr
Park City, UT 84098-5791
Phone (435) 649-5200

Other identifiers 5

IdentifierTypeStateIssuer
0483072MedicaidMT
28091OtherMTBLUE CROSS BLUE SHIELD MT
DB9976OtherMTRR MCR GROUP # (ODPC)
121304100MedicaidWY
OD 075 MTMedicaidAK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221229002167 UT Practitioner - Optometry 5799758389 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dr Cory B Seitz OD PCGroup PAC ID 3274943857, 2 clinicians

Practice addresses (Care Compare)

345 W 600
Suite 300
Heber City, UT 84032-2268
Phone (435) 654-1863

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
757 OPTMTMDOptometrist
12983357-9934UTMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Cory B. Seitz O.D.,P.C. Optometrist CurrentSince Mar 8, 2023 Accepting new patients

Locations

345 W 600 S
Ste 300
Heber City, UT 84032
Phone (435) 654-1863

Networks

  • UT PPO D-SNP
  • UT PPO

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685491200000",
    "number": "1205927175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 S 1970 E",
            "city": "HEBER CITY",
            "state": "UT",
            "postal_code": "840324420",
            "telephone_number": "406-565-8298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 W 600 S STE 300",
            "city": "HEBER CITY",
            "state": "UT",
            "postal_code": "840322268",
            "telephone_number": "435-654-1863"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6584 Creekside Dr",
            "address_purpose": "LOCATION",
            "city": "Park City",
            "state": "UT",
            "postal_code": "840985791",
            "country_code": "US",
            "telephone_number": "435-649-5200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONSON",
        "first_name": "MICHAEL",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MT",
            "license": "757 OPT",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "12983357-9934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0483072",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MT",
            "identifier": "28091",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR GROUP # (ODPC)",
            "identifier": "DB9976",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121304100",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OD 075 MT",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Heber City, UT

Sources for this page

Verify at the official NPI Registry.