Provider Demographics
NPI:1326194820
Name:MOSER, JAMES EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:MOSER
Suffix:
Gender:M
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 970
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110-0970
Mailing Address - Country:US
Mailing Address - Phone:307-885-3975
Mailing Address - Fax:
Practice Address - Street 1:50 EAST 4TH AVE.
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-0970
Practice Address - Country:US
Practice Address - Phone:307-885-3975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY145T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY104044800Medicaid
WY0362660001OtherMEDICARE DME PROVIDER #
WYW4590723Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
WY104044800Medicaid