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1346724556 NPI number — KAITLIN MICHELLE MOONEY OD

NPI Number: 1346724556
Health Care Provider/Practitioner: KAITLIN MICHELLE MOONEY OD

Information about “1346724556” NPI (KAITLIN MICHELLE MOONEY OD) exists in 1346724556 in HTML format HTML  |  1346724556 in plain Text format TXT  |  1346724556 in PDF (Portable Document Format) PDF  |  1346724556 in an XML format XML  formats.

NPI Number : 1346724556 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1346724556",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MOONEY",
    "FirstName": "KAITLIN",
    "MiddleName": "MICHELLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "OD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "116 PLOVER LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROCKLEDGE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32955-5766",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "845-863-9091",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3200 N WICKHAM RD STE 1",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MELBOURNE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32935-2321",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "321-253-3550",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/24/2018",
    "LastUpdateDate": "04/02/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "008806",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "6431",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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