MEDICARE: CATHY MOON

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	TUV008900-1	NY
2	152W00000X	Optometrist	OEG003505	PA

General Provider Information

NPI Number	:	1043788946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHY MOON

Provider Business Mailing Address
First Line	:	1523 WALNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3001
Country	:	US
Telephone Number	:	215-845-0987
Fax Number	:

Provider Business Practice Location Address
First Line	:	1523 WALNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3001
Country	:	US
Telephone Number	:	215-845-0987
Fax Number	:

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

Provider Enumeration Date	:	11/08/2018
Last Update Date	:	12/24/2019

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Directions to “ CATHY MOON ” Practice Location

Language	Start Address	Practice Location

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