MEDICARE: DR. CHRISTOPHER DAVID 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	4830	NJ

General Provider Information

NPI Number	:	1952376543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER DAVID MOORE O.D.

Provider Business Mailing Address
First Line	:	12 ELAINE CT
Second Line	:
City	:	CALIFON
State	:	NJ
Zip	:	07830-3554
Country	:	US
Telephone Number	:	201-420-9471
Fax Number	:	201-420-9923

Provider Business Practice Location Address
First Line	:	30 MALL DR W # 103A
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07310-1615
Country	:	US
Telephone Number	:	201-420-9471
Fax Number	:	201-420-9923

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	07/08/2007

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