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General NPI Number Information
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NPI Number | 1548455561
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Entity Type | Organization
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Legal Business Name | GARY M. MOSS, O.D.
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 11/06/2009
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Provider Practice Location Address
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Address Line | 1769 WASHTENAW RD
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City | YPSILANTI
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State | MI
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Zip | 48197-2020
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Country | US
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Telephone | 734-483-2100
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Fax | 734-483-2060
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Provider Business Mailing Address
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Address Line | 1769 WASHTENAW RD
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City | YPSILANTI
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State | MI
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Zip | 48197-2020
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Country | US
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Telephone | 734-483-2100
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Fax | 734-483-2060
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Authorized Official
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Title or Position | OPTOMETRIST/ OWNER
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Name | DR. GARY M MOSS
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Credential | OD
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Telephone | 734-483-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 4901002648
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License Number State | MI
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