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General NPI Number Information
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NPI Number | 1285862490
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Entity Type | Organization
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Legal Business Name | PATRICIA M MOSER OD PC
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Dates
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Enumeration Date | 06/25/2009
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Last Update Date | 06/25/2009
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Provider Practice Location Address
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Address Line | 122-24 BROADVIEW VILLAGE SQUARE
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City | BROADVIEW
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State | IL
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Zip | 60155
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Country | US
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Telephone | 708-343-2099
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Fax | 708-343-2081
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Provider Business Mailing Address
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Address Line | 704 KRISTIN CT
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City | WESTMONT
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State | IL
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Zip | 60559-3330
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICIA M. MOSER
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Credential | O.D.
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Telephone | 708034302099
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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 | 046008530
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License Number State | IL
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