MEDICARE: VERONICA MOORE-STOLL OD

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	TUV009540-01	NY

General Provider Information

NPI Number	:	1013640556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA MOORE-STOLL OD

Provider Business Mailing Address
First Line	:	536 E 82ND ST APT 1F
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-7173
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 GRAND CONCOURSE STE B6
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-1265
Country	:	US
Telephone Number	:	718-741-3200
Fax Number	:

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

Provider Enumeration Date	:	07/01/2022
Last Update Date	:	07/01/2022

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