Provider Demographics
NPI:1255323796
Name:MOCH, DANELLE F (OD)
Entity Type:Individual
Prefix:DR
First Name:DANELLE
Middle Name:F
Last Name:MOCH
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 1:3221 BAY SHORE PL SE
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-6261
Mailing Address - Country:US
Mailing Address - Phone:701-663-4598
Mailing Address - Fax:
Practice Address - Street 1:1221 W DIVIDE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1290
Practice Address - Country:US
Practice Address - Phone:701-224-0661
Practice Address - Fax:701-224-0663
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND622152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist