Provider Demographics
NPI:1477336758
Name:MORALES, EDUARDO (LDO)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:MORALES
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13427 HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:TRION
Mailing Address - State:GA
Mailing Address - Zip Code:30753-1549
Mailing Address - Country:US
Mailing Address - Phone:706-734-2864
Mailing Address - Fax:
Practice Address - Street 1:13427 HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:TRION
Practice Address - State:GA
Practice Address - Zip Code:30753-1549
Practice Address - Country:US
Practice Address - Phone:706-734-2864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002417156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician