Healthcare Provider Details

I. General information

NPI: 1174535173
Provider Name (Legal Business Name): HOLLY MOSKOS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W GROVE ST SUITE #101
MIDDLEBORO MA
02346-1458
US

IV. Provider business mailing address

212 FORBES RD
ROCHESTER MA
02770-1039
US

V. Phone/Fax

Practice location:
  • Phone: 508-947-7321
  • Fax:
Mailing address:
  • Phone: 774-406-9226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4354
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: