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General NPI Number Information
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NPI Number | 1326213992
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Entity Type | Organization
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Legal Business Name | MICHAEL D MOORE OD PS INC
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2600 MARTIN WAY E STE C
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City | OLYMPIA
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State | WA
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Zip | 98506-4974
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Country | US
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Telephone | 360-357-7899
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Fax | 360-357-6495
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Provider Business Mailing Address
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Address Line | 2600 MARTIN WAY E STE C
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City | OLYMPIA
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State | WA
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Zip | 98506-4974
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Country | US
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Telephone | 360-357-7899
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Fax | 360-357-6495
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MICHAEL D MOORE
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Credential | OD
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Telephone | 360-357-7899
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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 | 1010
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License Number State | WA
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