Provider Demographics
NPI:1205209814
Name:MOORE, STEVEN FRANCIS (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:FRANCIS
Last Name:MOORE
Suffix:
Gender:M
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:W6899 STATE HIGHWAY M69
Mailing Address - Street 2:
Mailing Address - City:FELCH
Mailing Address - State:MI
Mailing Address - Zip Code:49831-8601
Mailing Address - Country:US
Mailing Address - Phone:713-878-4242
Mailing Address - Fax:
Practice Address - Street 1:325 E H ST
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-4760
Practice Address - Country:US
Practice Address - Phone:906-774-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005101152W00000X
TX8796TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist