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General NPI Number Information
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NPI Number | 1275866683
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Entity Type | Individual
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Provider Name | SHONDRA MOORE O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 2001 MILLERVILLE RD
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City | BATON ROUGE
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State | LA
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Zip | 70816-1408
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Country | US
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Telephone | 225-372-6170
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Fax | 504-486-8985
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Provider Business Mailing Address
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Address Line | 2880 CRESTHAVEN AVE
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City | BATON ROUGE
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State | LA
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Zip | 70810-0464
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Country | US
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Telephone | 615-828-3904
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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 | 1579-612T
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License Number State | LA
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