Provider Demographics
NPI:1386217487
Name:MOLLER, ESTHER (OD)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:MOLLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:
Other - Last Name:MOSESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:715 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5311
Mailing Address - Country:US
Mailing Address - Phone:347-988-9555
Mailing Address - Fax:
Practice Address - Street 1:79 MIDDLEVILLE RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2200
Practice Address - Country:US
Practice Address - Phone:631-261-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV009348-01152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist