Healthcare Provider Details

I. General information

NPI: 1265510408
Provider Name (Legal Business Name): JANICE D MOYER M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15051 HESPERIAN BLVD SUITE A
SAN LEANDRO CA
94578-3536
US

IV. Provider business mailing address

8541 S STATE ST
CHICAGO IL
60619-5665
US

V. Phone/Fax

Practice location:
  • Phone: 510-276-1212
  • Fax: 510-276-1313
Mailing address:
  • Phone: 773-994-9440
  • Fax: 773-994-8166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA101000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: