Healthcare Provider Details

I. General information

NPI: 1871038323
Provider Name (Legal Business Name): TIMOTHY MOORE, O.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10627 PROFESSIONAL CIR STE B
RENO NV
89521-5834
US

IV. Provider business mailing address

10627 PROFESSIONAL CIR STE B
RENO NV
89521-5834
US

V. Phone/Fax

Practice location:
  • Phone: 775-507-7171
  • Fax: 775-507-7172
Mailing address:
  • Phone: 775-507-7171
  • Fax: 775-507-7172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY BRIAN MOORE
Title or Position: PRESIDENT
Credential: O.D.
Phone: 775-507-7171