Healthcare Provider Details

I. General information

NPI: 1679994271
Provider Name (Legal Business Name): SPENCER T MOY OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2013
Last Update Date: 12/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 MOTT ST STE. 303
NEW YORK NY
10013-5540
US

IV. Provider business mailing address

128 MOTT ST STE. 303
NEW YORK NY
10013-5540
US

V. Phone/Fax

Practice location:
  • Phone: 646-649-3430
  • Fax:
Mailing address:
  • Phone: 646-649-3430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number004921
License Number StateNY

VIII. Authorized Official

Name: SPENCER T. MOY
Title or Position: OD/OWNER
Credential: OD
Phone: 646-649-3430