=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063004752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | W.HAMPTON MOORE OD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2021
-----------------------------------------------------
Last Update Date | 02/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1593 DARBY DR
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35630-2746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-767-5522
-----------------------------------------------------
Fax | 256-767-6114
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1593 DARBY DR
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35630-2746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-767-5522
-----------------------------------------------------
Fax | 256-767-6114
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. WARREN HAMPTON MOORE
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 256-767-5522
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------