MEDICARE: DR. ANNA L.O. MOORE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1922	AZ

General Provider Information

NPI Number	:	1013330745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA L.O. MOORE O.D.

Provider Business Mailing Address
First Line	:	18325 N ALLIED WAY STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85054-3106
Country	:	US
Telephone Number	:	623-467-4966
Fax Number	:	480-419-5401

Provider Business Practice Location Address
First Line	:	18325 N ALLIED WAY STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85054-3106
Country	:	US
Telephone Number	:	602-467-4966
Fax Number	:	480-419-5401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2014
Last Update Date	:	05/29/2026

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