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General NPI Number Information
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NPI Number | 1912096967
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Entity Type | Individual
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Provider Name | KANDI SUE MOLLER OD
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Gender | Female
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 07/11/2020
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Provider Practice Location Address
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Address Line | 4735 POINT FOSDICK DR STE 300
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City | GIG HARBOR
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State | WA
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Zip | 98335-2314
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Country | US
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Telephone | 253-432-4303
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Fax |
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Provider Business Mailing Address
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Address Line | 14014 82ND AVE NW
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City | GIG HARBOR
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State | WA
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Zip | 98329-8855
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Country | US
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Telephone | 541-979-1106
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Fax | 253-514-6719
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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 | 2733ATI
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 193400000X
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Taxonomy Name | Single Specialty Group
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License Number | 2733ATI
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD60958770
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License Number State | WA
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