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General NPI Number Information
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NPI Number | 1962537993
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Entity Type | Organization
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Legal Business Name | DR. E. JACK MOOMEY, PC
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 127 S BELAIR RD
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City | MARTINEZ
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State | GA
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Zip | 30907-9111
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Country | US
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Telephone | 706-869-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 127 S BELAIR RD
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City | MARTINEZ
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State | GA
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Zip | 30907-9111
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Country | US
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Telephone | 706-869-1800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELTON JACK MOOMEY
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Credential | OD
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Telephone | 706-869-1800
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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 | OPT000709
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License Number State | GA
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