MEDICARE: DR. DAVID 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	1350	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TN1350	OTHER	TN	TN LICENSE

General Provider Information

NPI Number	:	1376587436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID MOSS O.D.

Provider Business Mailing Address
First Line	:	2705 APPLING RD
Second Line	:	STE. 102
City	:	MEMPHIS
State	:	TN
Zip	:	38133-5082
Country	:	US
Telephone Number	:	901-266-7189
Fax Number	:	901-382-8994

Provider Business Practice Location Address
First Line	:	2705 APPLING RD
Second Line	:	STE. 102
City	:	MEMPHIS
State	:	TN
Zip	:	38133-5082
Country	:	US
Telephone Number	:	901-266-7189
Fax Number	:	901-382-8994

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. DAVID MOSS O.D.” Practice Location

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