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General NPI Number Information
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NPI Number | 1043408958
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Entity Type | Organization
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Legal Business Name | EDWARD J MOYLAN OD PC
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 03/12/2022
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Provider Practice Location Address
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Address Line | 537 PATCHOGUE RD
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1006
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Country | US
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Telephone | 631-642-2020
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Fax | 631-642-3938
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Provider Business Mailing Address
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Address Line | 537 PATCHOGUE RD
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1006
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Country | US
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Telephone | 631-642-2020
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Fax | 631-642-3938
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. EDWARD J MOYLAN
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Credential | OD
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Telephone | 631-642-2020
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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 | TUV004922-1
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License Number State | NY
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