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General NPI Number Information
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NPI Number | 1053631770
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Entity Type | Organization
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Legal Business Name | MOORE FAMILY EYECARE, LLC
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Dates
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Enumeration Date | 06/04/2010
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 1902 WEST 19TH STREET STE. A
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City | MOUNTAIN GROVE
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State | MO
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Zip | 65711-1221
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Country | US
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Telephone | 417-926-3937
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Fax | 417-926-3952
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Provider Business Mailing Address
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Address Line | 1902 WEST 19TH STREET STE. A
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City | MOUNTAIN GROVE
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State | MO
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Zip | 65711-1221
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Country | US
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Telephone | 417-926-3937
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Fax | 417-926-3952
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Authorized Official
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Title or Position | MEMBER
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Name | DR. DOUGLAS LORAN MOORE
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Credential | O.D.
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Telephone | 417-926-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | T03463
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License Number State | MO
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