Provider Demographics
NPI:1265510408
Name:MOYER, JANICE D (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:D
Last Name:MOYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8541 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-5665
Mailing Address - Country:US
Mailing Address - Phone:773-994-9440
Mailing Address - Fax:773-994-8166
Practice Address - Street 1:15051 HESPERIAN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-3536
Practice Address - Country:US
Practice Address - Phone:510-276-1212
Practice Address - Fax:510-276-1313
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101000207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109457OtherIL.LICENSE NUMBER
IL428000OtherMEDICARE GROUP NUMBER
IL336070411OtherCONTROLLED SUBSTANCE
IL036109457OtherIL.LICENSE NUMBER
IL428000OtherMEDICARE GROUP NUMBER