Provider Demographics
NPI:1154326726
Name:MOODY, EVERETT ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:EVERETT
Middle Name:ALBERT
Last Name:MOODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 N MACARTHUR BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-4404
Mailing Address - Country:US
Mailing Address - Phone:972-258-7979
Mailing Address - Fax:972-570-5502
Practice Address - Street 1:3200 N MACARTHUR BLVD
Practice Address - Street 2:STE 200
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-4404
Practice Address - Country:US
Practice Address - Phone:972-258-7979
Practice Address - Fax:972-570-5502
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2021-06-01
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
TXD0977207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74309OtherAMERIGROUP ID
TX8091K0OtherBLUE CROSS BLUE SHEILD
TX9001OtherCOMMISSION FOR THE BLIND
TX4821OtherPARKLAND MEDICAID ID
TX11369OtherOPTICARE ID
TX2224973OtherBLUE LINK ID
TX8091K0OtherBLUE CROSS BLUE SHEILD
TXB24973Medicare UPIN
TX2224973OtherBLUE LINK ID