Provider Demographics
NPI:1376587436
Name:MOSS, DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:MOSS
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 1:2705 APPLING RD
Mailing Address - Street 2:STE. 102
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-5082
Mailing Address - Country:US
Mailing Address - Phone:901-266-7189
Mailing Address - Fax:901-382-8994
Practice Address - Street 1:2705 APPLING RD
Practice Address - Street 2:STE. 102
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-5082
Practice Address - Country:US
Practice Address - Phone:901-266-7189
Practice Address - Fax:901-382-8994
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1350152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN1350OtherTN LICENSE
TNU16351Medicare UPIN
TNTN1350OtherTN LICENSE