Healthcare Provider Details

I. General information

NPI: 1861785701
Provider Name (Legal Business Name): DR. MO'S EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CLEMENTS BRIDGE RD STE 116
DEPTFORD NJ
08096-2016
US

IV. Provider business mailing address

2433 LAFAYETTE AVE
ROSLYN PA
19001-4206
US

V. Phone/Fax

Practice location:
  • Phone: 856-384-2501
  • Fax: 856-384-2503
Mailing address:
  • Phone: 856-577-3471
  • Fax: 215-884-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: KELLY MOLOCK-HEROLD
Title or Position: OPTOMETRIST
Credential: O.D
Phone: 856-577-3471