MEDICARE: SPENCER T MOY 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	UVT4921	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25533B	OTHER	NY	GHI - MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1710973557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPENCER T MOY OD

Provider Business Mailing Address
First Line	:	1248 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4102
Country	:	US
Telephone Number	:	718-336-1213
Fax Number	:

Provider Business Practice Location Address
First Line	:	1248 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4102
Country	:	US
Telephone Number	:	718-336-1213
Fax Number	:

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	09/10/2007

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