Provider Demographics
NPI:1437177813
Name:MOORE, JASON WINTHROP (OD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:WINTHROP
Last Name:MOORE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2672 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3054
Mailing Address - Country:US
Mailing Address - Phone:585-245-0471
Mailing Address - Fax:585-227-6963
Practice Address - Street 1:2672 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-3054
Practice Address - Country:US
Practice Address - Phone:585-245-0471
Practice Address - Fax:585-227-6963
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT006526-1152W00000X, 152WC0802X, 152WP0200X, 152WV0400X
NYTUV006526152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU92862Medicare UPIN