Healthcare Provider Details

I. General information

NPI: 1235125485
Provider Name (Legal Business Name): VALERIE L MOATES O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 E LAMAR ST
AMERICUS GA
31709-3762
US

IV. Provider business mailing address

1119 E LAMAR ST P. O. BOX 788
AMERICUS GA
31709-3762
US

V. Phone/Fax

Practice location:
  • Phone: 229-924-4022
  • Fax: 229-924-7133
Mailing address:
  • Phone: 229-924-4022
  • Fax: 229-924-7133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number001169
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: