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General NPI Number Information
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NPI Number | 1861463960
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Entity Type | Individual
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Provider Name | ANN GROOMER MOORE O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/28/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 6566 GLENWOOD AVE
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City | RALEIGH
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State | NC
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Zip | 27612-7156
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Country | US
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Telephone | 919-783-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 8311 BANDFORD WAY SUITE 105
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City | RALEIGH
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State | NC
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Zip | 27615-2756
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Country | US
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Telephone | 919-870-1880
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Fax | 919-847-4509
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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 | 1321
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License Number State | NC
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