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General NPI Number Information
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NPI Number | 1952749681
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Entity Type | Individual
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Provider Name | JESSICA MOON M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/04/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 88 ANSEL HALLET RD
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City | WEST YARMOUTH
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State | MA
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Zip | 02673
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Country | US
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Telephone | 508-771-4848
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Fax | 508-771-4848
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Provider Business Mailing Address
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Address Line | 88 ANSEL HALLET RD
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City | WEST YARMOUTH
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State | MA
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Zip | 02673-2556
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Country | US
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Telephone | 508-771-4848
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Fax | 508-771-4848
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 274842
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD182052
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License Number State | OR
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