MEDICARE: DR. MICHAEL R MOORE 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	1661	KS
2	152W00000X	Optometrist	2001018944	MO

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	:	1164457800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL R MOORE OD

Provider Business Mailing Address
First Line	:	7935 N BROADWAY ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-1410
Country	:	US
Telephone Number	:	816-682-8504
Fax Number	:

Provider Business Practice Location Address
First Line	:	7935 N BROADWAY ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-1410
Country	:	US
Telephone Number	:	816-682-8504
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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