Provider Demographics
NPI:1063460509
Name:MOORE, DIONNE EVA (OD)
Entity Type:Individual
Prefix:
First Name:DIONNE
Middle Name:EVA
Last Name:MOORE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W. 20TH ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052
Mailing Address - Country:US
Mailing Address - Phone:440-244-3833
Mailing Address - Fax:
Practice Address - Street 1:205 W 20TH ST
Practice Address - Street 2:LORAIN CBOC
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-3779
Practice Address - Country:US
Practice Address - Phone:440-244-3833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT 5498152W00000X
OHT 2410152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist