MEDICARE: KERRY J MOSCOVITZ O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3313TX	WA

General Provider Information

NPI Number	:	1023127776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY J MOSCOVITZ O.D.

Provider Business Mailing Address
First Line	:	22741 SE 29TH ST
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98075-9532
Country	:	US
Telephone Number	:	425-392-2196
Fax Number	:	425-392-8934

Provider Business Practice Location Address
First Line	:	22741 SE 29TH ST
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98075-9532
Country	:	US
Telephone Number	:	425-392-2196
Fax Number	:	425-392-8934

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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