Provider Demographics
NPI:1336134980
Name:MOORE, TORY W (OD)
Entity Type:Individual
Prefix:DR
First Name:TORY
Middle Name:W
Last Name:MOORE
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 1:1301 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029-3567
Mailing Address - Country:US
Mailing Address - Phone:806-935-2020
Mailing Address - Fax:806-934-9908
Practice Address - Street 1:1301 E 1ST ST
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-3567
Practice Address - Country:US
Practice Address - Phone:806-935-2020
Practice Address - Fax:806-934-9908
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4305 T G332H00000X
TX4305TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019278301Medicaid
TX019278302Medicaid
TX019278301Medicaid