Provider Demographics
NPI:1285851717
Name:MORAN, ANNA M (OD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:MORAN
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:PO BOX 812
Mailing Address - Street 2:
Mailing Address - City:GLIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97443-0812
Mailing Address - Country:US
Mailing Address - Phone:541-496-3685
Mailing Address - Fax:
Practice Address - Street 1:1400 NW GARDEN VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1766
Practice Address - Country:US
Practice Address - Phone:541-440-3816
Practice Address - Fax:541-673-7996
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3050T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist