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NPI Code Detail

MEDICARE: DR. DOUGLAS LORAN MOORE OD

MEDICARE: DR. DOUGLAS LORAN 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
1152W00000XOptometristT03463MO

General Provider Information

NPI Number : 1679574396
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DOUGLAS LORAN MOORE OD
Provider Business Mailing Address
First Line : 1902 W 19TH ST
Second Line : SUITE A
City : MOUNTAIN GROVE
State : MO
Zip : 65711-1287
Country : US
Telephone Number : 417-926-3937
Fax Number : 417-926-3952
Provider Business Practice Location Address
First Line : 1902 W 19TH ST
Second Line : SUITE A
City : MOUNTAIN GROVE
State : MO
Zip : 65711-1287
Country : US
Telephone Number : 417-926-3937
Fax Number : 417-926-3952
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2005
Last Update Date : 08/14/2020

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