Provider Demographics
NPI:1205212446
Name:MOSLEY, ELIZABETH MAY (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MAY
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:3333 HAZELTON RD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4204
Mailing Address - Country:US
Mailing Address - Phone:952-926-6149
Mailing Address - Fax:952-926-2729
Practice Address - Street 1:19576 HOLT ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1287
Practice Address - Country:US
Practice Address - Phone:763-241-2083
Practice Address - Fax:763-241-3801
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN3531152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist