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General NPI Number Information
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NPI Number | 1295112100
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Entity Type | Organization
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Legal Business Name | MICHAEL J MOSES O.D., INC
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Dates
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Enumeration Date | 04/29/2015
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Last Update Date | 04/29/2015
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Provider Practice Location Address
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Address Line | 4104 E STAN SCHLUETER LOOP 6
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City | KILLEEN
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State | TX
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Zip | 76542-7872
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Country | US
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Telephone | 254-690-8999
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Fax |
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Provider Business Mailing Address
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Address Line | 4104 E STAN SCHLUETER LOOP 6
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City | KILLEEN
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State | TX
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Zip | 76542-7872
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Country | US
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Telephone | 254-690-8999
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL JOSEPH MOSES
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Credential | O.D.
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Telephone | 254-289-5197
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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 | 4520-TG
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License Number State | TX
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