MEDICARE: MORGAN B. MOORE 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	2859TG	TX

General Provider Information

NPI Number	:	1932101441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN B. MOORE O.D.

Provider Business Mailing Address
First Line	:	902 W KRAMER RD
Second Line	:
City	:	BURKBURNETT
State	:	TX
Zip	:	76354-2640
Country	:	US
Telephone Number	:	940-569-4131
Fax Number	:	940-569-4648

Provider Business Practice Location Address
First Line	:	902 W KRAMER RD
Second Line	:
City	:	BURKBURNETT
State	:	TX
Zip	:	76354-2640
Country	:	US
Telephone Number	:	940-569-4131
Fax Number	:	940-569-4648

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	12/31/2007

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