Provider Demographics
NPI:1033161195
Name:ROBERT W MOSES O.D. PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ROBERT W MOSES O.D. PROFESSIONAL CORPORATION
Other - Org Name:MOSES EYECARE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:219-736-2020
Mailing Address - Street 1:70 E 68TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-3506
Mailing Address - Country:US
Mailing Address - Phone:219-736-2020
Mailing Address - Fax:219-769-3884
Practice Address - Street 1:70 E 68TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-3506
Practice Address - Country:US
Practice Address - Phone:219-736-2020
Practice Address - Fax:219-769-3884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001579152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCF9874OtherRAILROAD MEDICARE
INCG4140OtherRAILROAD MEDICARE
INCB2559OtherRAILROAD MEDICARE
INCF9875OtherRAILROAD MEDICARE
IN100167770Medicaid
IN0142650002Medicare NSC
IN0142650003Medicare NSC
INCB2559OtherRAILROAD MEDICARE
IN100167770Medicaid
IN436640Medicare PIN
IN0142650001Medicare NSC
IN179800Medicare PIN
IN496000Medicare PIN