Provider Demographics
NPI:1063004752
Name:W.HAMPTON MOORE OD PC
Entity Type:Organization
Organization Name:W.HAMPTON MOORE OD PC
Other - Org Name:RENAISSANCE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:HAMPTON
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-767-5522
Mailing Address - Street 1:1593 DARBY DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-2746
Mailing Address - Country:US
Mailing Address - Phone:256-767-5522
Mailing Address - Fax:256-767-6114
Practice Address - Street 1:1593 DARBY DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2746
Practice Address - Country:US
Practice Address - Phone:256-767-5522
Practice Address - Fax:256-767-6114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL300014794Medicaid