Healthcare Provider Details

I. General information

NPI: 1255175451
Provider Name (Legal Business Name): LAURA MOYER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 W MICHIGAN ST STE 100
INDIANAPOLIS IN
46202-5209
US

IV. Provider business mailing address

PO BOX 7079
INDIANAPOLIS IN
46207-7079
US

V. Phone/Fax

Practice location:
  • Phone: 317-278-1470
  • Fax:
Mailing address:
  • Phone: 317-278-1470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004518A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: