Provider Demographics
NPI:1417146994
Name:MOSES VISION CARE LLC
Entity Type:Organization
Organization Name:MOSES VISION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRODERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:832-859-2394
Mailing Address - Street 1:4500 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-5330
Mailing Address - Country:US
Mailing Address - Phone:504-454-3791
Mailing Address - Fax:504-456-3058
Practice Address - Street 1:4500 VETERANS MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-5330
Practice Address - Country:US
Practice Address - Phone:504-454-3791
Practice Address - Fax:504-456-3058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6684TG152W00000X, 261Q00000X
LA1383-519T261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1417146994OtherBLUE CROSS BLUE SHIELD OF TEXAS
LA1627348Medicaid
LA1627348Medicaid