MEDICARE: DR. LEE ANN MOLL 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	3892T	TX

General Provider Information

NPI Number	:	1174707087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE ANN MOLL O.D.

Provider Business Mailing Address
First Line	:	4102 JACKSBORO HWY STE 100
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76302-2747
Country	:	US
Telephone Number	:	940-696-9072
Fax Number	:	940-761-1115

Provider Business Practice Location Address
First Line	:	4102 JACKSBORO HWY STE 100
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76302-2747
Country	:	US
Telephone Number	:	940-696-9072
Fax Number	:	940-761-1115

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

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	12/27/2007

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