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NPI Code Detail

MEDICARE: MRS. ANESSA RAE MOODY

MEDICARE: MRS. ANESSA RAE MOODY
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
1156FX1800XOpticianOP016963.SOH

General Provider Information

NPI Number : 1205534138
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANESSA RAE MOODY
Provider Business Mailing Address
First Line : 6244 WILMINGTON PIKE
Second Line :
City : CENTERVILLE
State : OH
Zip : 45459-7024
Country : US
Telephone Number : 937-848-2243
Fax Number : 937-848-2498
Provider Business Practice Location Address
First Line : 6244 WILMINGTON PIKE
Second Line :
City : CENTERVILLE
State : OH
Zip : 45459-7024
Country : US
Telephone Number : 937-848-2243
Fax Number : 937-848-2498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2023
Last Update Date : 02/20/2023

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Directions to “ MRS. ANESSA RAE MOODY ” Practice Location

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