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General NPI Number Information
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NPI Number | 1194795971
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Entity Type | Individual
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Provider Name | MICHELLE ELIZABETH MOORE O. D.
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Gender | Female
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 683 BROAD ST
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City | BRISTOL
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State | CT
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Zip | 06010-6662
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Country | US
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Telephone | 860-583-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 11 CROWN ST
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City | PLAINVILLE
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State | CT
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Zip | 06062-2214
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Country | US
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Telephone | 860-793-1330
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Fax |
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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 | CT2482
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License Number State | CT
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