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General NPI Number Information
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NPI Number | 1073513057
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Entity Type | Individual
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Provider Name | MARY JO BAIZE-MOORE O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/30/2005
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 1806 N 4TH ST
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City | MURRAY
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State | KY
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Zip | 42071-9815
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Country | US
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Telephone | 270-759-1429
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Fax | 270-759-1493
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Provider Business Mailing Address
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Address Line | 1806 N 4TH ST
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City | MURRAY
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State | KY
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Zip | 42071-9815
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Country | US
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Telephone | 270-759-1429
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Fax | 270-759-1493
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPC 2467
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2300DT
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License Number State | KY
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