Provider Demographics
NPI:1225183593
Name:MOSER, ANN MARGARET (OD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:MARGARET
Last Name:MOSER
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 1:38 OLD DUCK HOLE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2504
Mailing Address - Country:US
Mailing Address - Phone:203-245-3973
Mailing Address - Fax:
Practice Address - Street 1:105 ELM ST
Practice Address - Street 2:UNIT 16 - OLD SAYBROOK SHOPPING CENTER
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-4132
Practice Address - Country:US
Practice Address - Phone:860-388-4394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2504152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTR75881Medicare UPIN