MEDICARE: MORA EYE CLINIC

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	3202TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891917167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORA EYE CLINIC

Provider Business Mailing Address
First Line	:	1601 CORPUS CHRISTI ST
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78043-3302
Country	:	US
Telephone Number	:	956-726-1007
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 CORPUS CHRISTI ST
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78043-3302
Country	:	US
Telephone Number	:	956-726-1007
Fax Number	:

Authorized Official
Title or Position	:	OWNER , OPTOMETRIST
Name	:	DR. DAVID SAUL MORA
Credential	:	O.D. , PH.D.
Telephone Number	:	956-726-1007

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	05/14/2011

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Directions to “MORA EYE CLINIC ” Practice Location

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