Healthcare Provider Details

I. General information

NPI: 1346217536
Provider Name (Legal Business Name): MOORE VISION P.C. DBA PREMIER FAMILY EYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 EAGLE DR
LOVELAND CO
80537-8020
US

IV. Provider business mailing address

1123 EAGLE DR
LOVELAND CO
80537-8020
US

V. Phone/Fax

Practice location:
  • Phone: 970-622-0646
  • Fax:
Mailing address:
  • Phone: 970-622-0646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. DIANA LYNNE MOORE
Title or Position: V.P./OPTOMETRIST
Credential: O.D.
Phone: 970-622-0646