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General NPI Number Information
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NPI Number | 1528440328
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Entity Type | Individual
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Provider Name | CAITLYN MOORE O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/29/2015
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 140 PEACHTREE PLZ
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City | BROWNSVILLE
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State | TN
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Zip | 38012-2500
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Country | US
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Telephone | 731-772-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 11860 CRANSTON DR
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City | ARLINGTON
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State | TN
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Zip | 38002-4886
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Country | US
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Telephone | 901-867-5540
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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 | 3251
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License Number State | TN
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