Bennett Fasbender, Monique Nicole

Bennett Fasbender, Monique Nicole is an individual health care provider with primary practice located at 251 2Nd St , Reedsburg WI 53959-1610. She recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Corneal and Contact Management. Eye and Vision Services Providers / Optometrist is her primary health care specialty. Bennett Fasbender, Monique Nicole can be contacted via phone (608) 524-4334.

Contact Information

Primary practice address
251 2Nd St Reedsburg WI 53959-1610
Phone: (608) 524-4334
Fax: (608) 524-4335
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 8606T Texas
Eye and Vision Services Providers / Corneal and Contact Management 152WC0802X 8606T Texas
Eye and Vision Services Providers / Optometrist 152W00000X 3667-35 Wisconsin

Profile Details

NPI number 1962808295
LBN Legal business name Bennett Fasbender, Monique Nicole
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 13th, 2014
Last updated Aug 27th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962808295 NPPES
Wisconsin Other 3667-35 WISCONSIN OPTOMETRIC LICENSE
Wisconsin Other 8606T WISCONSIN OPTOMETRIC LICENSE

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