MEDICARE: ROGER A MOORE OPTOMETRIST

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	950	CT

General Provider Information

NPI Number	:	1518135672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROGER A MOORE OPTOMETRIST

Provider Business Mailing Address
First Line	:	14 CHURCH HILL RD # C10
Second Line	:
City	:	NEWTOWN
State	:	CT
Zip	:	06470-1640
Country	:	US
Telephone Number	:	203-426-2727
Fax Number	:	203-426-5113

Provider Business Practice Location Address
First Line	:	14 CHURCH HILL RD # C10
Second Line	:
City	:	NEWTOWN
State	:	CT
Zip	:	06470-1640
Country	:	US
Telephone Number	:	203-426-2727
Fax Number	:	203-426-5113

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROGER A. MOORE
Credential	:	O.D.
Telephone Number	:	203-426-2727

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	03/11/2011

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