MEDICARE: ROGER MOORE OD

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0123880001	OTHER	CT	MEDICARE - DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	090000950CT01	OTHER		ANTHEM BC
3	P620522	OTHER	CT	OXFORD
4	4321240	OTHER		AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669476214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER MOORE OD

Provider Business Mailing Address
First Line	:	14 CHURCH HILL RD
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
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	08/06/2012

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Directions to “ ROGER MOORE OD” Practice Location

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