Provider Demographics
NPI:1033148945
Name:MOATS, AARON ALVIE (OD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:ALVIE
Last Name:MOATS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3128
Mailing Address - Country:US
Mailing Address - Phone:330-297-7733
Mailing Address - Fax:330-297-0170
Practice Address - Street 1:159 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3128
Practice Address - Country:US
Practice Address - Phone:330-297-7733
Practice Address - Fax:330-297-0170
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHT1593152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0526681Medicare PIN