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General NPI Number Information
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NPI Number | 1477629814
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Entity Type | Individual
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Provider Name | MICHAEL JOSEPH MOSES O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 04/16/2015
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Provider Practice Location Address
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Address Line | 4104 E STAN SCHLUETER LOOP STE 6
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City | KILLEEN
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State | TX
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Zip | 76542-7873
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Country | US
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Telephone | 254-690-8999
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Fax | 800-710-9601
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Provider Business Mailing Address
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Address Line | 45 VISTA DR
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City | BELTON
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State | TX
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Zip | 76513-6362
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Country | US
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Telephone | 254-780-2663
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4520TG
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License Number State | TX
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