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General NPI Number Information
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NPI Number | 1033161195
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Entity Type | Organization
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Legal Business Name | ROBERT W MOSES O.D. PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/03/2010
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Provider Practice Location Address
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Address Line | 70 E 68TH PL
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City | MERRILLVILLE
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State | IN
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Zip | 46410-3506
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Country | US
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Telephone | 219-736-2020
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Fax | 219-769-3884
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Provider Business Mailing Address
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Address Line | 70 E 68TH PL
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City | MERRILLVILLE
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State | IN
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Zip | 46410-3506
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Country | US
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Telephone | 219-736-2020
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Fax | 219-769-3884
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT WILLIAM MOSES
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Credential | O.D.
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Telephone | 219-736-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18001579
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License Number State | IN
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