Provider Demographics
NPI:1306039763
Name:MOSER & MOSER OPTOMETRISTS, INC
Entity Type:Organization
Organization Name:MOSER & MOSER OPTOMETRISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:765-552-7376
Mailing Address - Street 1:1900 S P ST
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46036-3333
Mailing Address - Country:US
Mailing Address - Phone:765-552-7376
Mailing Address - Fax:765-552-7377
Practice Address - Street 1:1900 S P ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-3333
Practice Address - Country:US
Practice Address - Phone:765-552-7376
Practice Address - Fax:765-552-7377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001779152W00000X
IN18001778152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100170840AMedicaid
IN100170930AMedicaid
IN504230Medicare PIN
IN504050Medicare PIN
INT34889Medicare UPIN
IN100170930AMedicaid
IN0534270001Medicare NSC