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General NPI Number Information
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NPI Number | 1871038323
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Entity Type | Organization
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Legal Business Name | TIMOTHY MOORE, O.D., P.C.
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 10627 PROFESSIONAL CIR STE B
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City | RENO
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State | NV
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Zip | 89521-5834
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Country | US
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Telephone | 775-507-7171
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Fax | 775-507-7172
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Provider Business Mailing Address
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Address Line | 10627 PROFESSIONAL CIR STE B
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City | RENO
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State | NV
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Zip | 89521-5834
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Country | US
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Telephone | 775-507-7171
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Fax | 775-507-7172
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY BRIAN MOORE
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Credential | O.D.
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Telephone | 775-507-7171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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