Healthcare Provider Details

I. General information

NPI: 1073006318
Provider Name (Legal Business Name): JEFFREY WILLIAM MOON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 REGENCY CT STE 100
TOLEDO OH
43623-3074
US

IV. Provider business mailing address

1000 REGENCY CT STE 100
TOLEDO OH
43623-3074
US

V. Phone/Fax

Practice location:
  • Phone: 419-882-0588
  • Fax: 419-885-3070
Mailing address:
  • Phone: 419-882-0588
  • Fax: 419-885-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35C.003813
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2022-02655
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: