MEDICARE: DR. MARSHALL NORMAN MOSS 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	OPC1170	FL
2	152WC0802X	Corneal and Contact Management Optometrist	OPC1170	FL
3	152WL0500X	Low Vision Rehabilitation Optometrist	OPC1170	FL
4	152WS0006X	Sports Vision Optometrist	OPC1170	FL
5	152WV0400X	Vision Therapy Optometrist	OPC1170	FL
6	152WX0102X	Occupational Vision Optometrist	OPC1170	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104846187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARSHALL NORMAN MOSS O.D.

Provider Business Mailing Address
First Line	:	1025 NE 172ND TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33162-2639
Country	:	US
Telephone Number	:	305-654-1121
Fax Number	:	305-940-2065

Provider Business Practice Location Address
First Line	:	1644 NE 164TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4017
Country	:	US
Telephone Number	:	305-940-2065
Fax Number	:	305-940-2065

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	03/21/2012

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