Provider Demographics
NPI:1376603746
Name:MOSER, PATRICIA M (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:M
Last Name:MOSER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4958 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3508
Mailing Address - Country:US
Mailing Address - Phone:630-737-1001
Mailing Address - Fax:630-737-1003
Practice Address - Street 1:4958 FOREST AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3508
Practice Address - Country:US
Practice Address - Phone:630-737-1001
Practice Address - Fax:630-737-1003
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46008530152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist