Individual
DR. MONIQUE NICOLE BENNETT FASBENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
251 2ND ST, REEDSBURG, WI 53959-1610
(608) 524-4334
(608) 524-4335
Mailing address
251 2ND ST, REEDSBURG, WI 53959-1610
(608) 524-4334
(608) 524-4335
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3667-35
WI
152W00000X
Optometrist
8606T
TX
152WC0802X
Corneal and Contact Management Optometrist
8606T
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3667-35
WISCONSIN OPTOMETRIC LICENSE
WI
01
—
8606T
TEXAS OPTOMETRIC LICENSE
TX
Enumeration date
11/13/2014
Last updated
08/27/2021
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