MEDICARE: DR. HOLLY MOSKOS 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	4354	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W17490	OTHER		MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1174535173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOLLY MOSKOS O.D.

Provider Business Mailing Address
First Line	:	212 FORBES RD
Second Line	:
City	:	ROCHESTER
State	:	MA
Zip	:	02770-1039
Country	:	US
Telephone Number	:	774-406-9226
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 W GROVE ST
Second Line	:	SUITE #101
City	:	MIDDLEBORO
State	:	MA
Zip	:	02346-1458
Country	:	US
Telephone Number	:	508-947-7321
Fax Number	:

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	02/12/2021

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Directions to “ DR. HOLLY MOSKOS O.D.” Practice Location

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