Provider Demographics
NPI:1437147147
Name:ISAAC MOORE MD
Entity Type:Organization
Organization Name:ISAAC MOORE MD
Other - Org Name:ALPHA EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-385-0033
Mailing Address - Street 1:PO BOX 13029
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-3029
Mailing Address - Country:US
Mailing Address - Phone:850-385-0033
Mailing Address - Fax:850-422-0201
Practice Address - Street 1:2160 CAPITAL CIR NE
Practice Address - Street 2:SUITE 200
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4390
Practice Address - Country:US
Practice Address - Phone:850-385-0033
Practice Address - Fax:850-422-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 31862207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00389496AMedicaid
FL039263400Medicaid
406182936OtherUNITED HEALTH CARE
406182936OtherRAILROAD MEDICARE
FLD79813Medicare UPIN
406182936OtherRAILROAD MEDICARE