MEDICARE: DR. JESSICA LEE LAMBERT MOORE 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	18003931A	IN

Other Identifiers

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

General Provider Information

NPI Number	:	1588004550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA LEE LAMBERT MOORE O.D.

Provider Business Mailing Address
First Line	:	11939 REDPOLL TRL
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-5028
Country	:	US
Telephone Number	:	765-748-0359
Fax Number	:

Provider Business Practice Location Address
First Line	:	5541 S SCATTERFIELD RD
Second Line	:
City	:	ANDERSON
State	:	IN
Zip	:	46013-3140
Country	:	US
Telephone Number	:	765-748-0359
Fax Number	:

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

Provider Enumeration Date	:	07/04/2013
Last Update Date	:	10/17/2023

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