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General NPI Number Information
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NPI Number | 1417146994
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Entity Type | Organization
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Legal Business Name | MOSES VISION CARE LLC
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 02/19/2019
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Provider Practice Location Address
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Address Line | 4500 VETERANS MEMORIAL BLVD
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City | METAIRIE
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State | LA
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Zip | 70006-5330
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Country | US
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Telephone | 504-454-3791
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Fax | 504-456-3058
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Provider Business Mailing Address
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Address Line | 4500 VETERANS MEMORIAL BLVD
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City | METAIRIE
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State | LA
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Zip | 70006-5330
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Country | US
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Telephone | 504-454-3791
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Fax | 504-456-3058
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. BRODERICK MOSES
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Credential | O.D.
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Telephone | 832-859-2394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1383-519T
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 6684TG
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 6684TG
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License Number State | TX
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