Provider Demographics
NPI:1093768012
Name:DR. CHRISTOPHER J. MOSHOURES OPTOMETRIST PA
Entity Type:Organization
Organization Name:DR. CHRISTOPHER J. MOSHOURES OPTOMETRIST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOSHOURES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:910-754-2020
Mailing Address - Street 1:PO BOX 867
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28459-0867
Mailing Address - Country:US
Mailing Address - Phone:910-754-2020
Mailing Address - Fax:910-754-8811
Practice Address - Street 1:4830 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-1912
Practice Address - Country:US
Practice Address - Phone:910-754-2020
Practice Address - Fax:910-754-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCDC7507OtherRAILROAD MEDICARE
NC0158BOtherBLUE CROSS BCBS SHIELD OF NC
NC890158BMedicaid
NC0158BOtherBLUE CROSS BCBS SHIELD OF NC
NCDC7507OtherRAILROAD MEDICARE