Provider Demographics
NPI:1275722738
Name:SHERL MOORE OD PLLC
Entity Type:Organization
Organization Name:SHERL MOORE OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:SHERL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:O D PLLC
Authorized Official - Phone:918-822-2248
Mailing Address - Street 1:415 N WILSON ST
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-2432
Mailing Address - Country:US
Mailing Address - Phone:918-256-5646
Mailing Address - Fax:918-256-7727
Practice Address - Street 1:415 N WILSON ST
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-2432
Practice Address - Country:US
Practice Address - Phone:918-256-5646
Practice Address - Fax:918-256-7727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2490152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty