Provider Demographics
NPI:1487833935
Name:DR PG MOERSCHELL OD INC
Entity Type:Organization
Organization Name:DR PG MOERSCHELL OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOERSCHELL
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:757-499-2389
Mailing Address - Street 1:291 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5481
Mailing Address - Country:US
Mailing Address - Phone:757-499-2389
Mailing Address - Fax:757-499-0696
Practice Address - Street 1:291 INDEPENDENCE BLVD
Practice Address - Street 2:STE 110
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5476
Practice Address - Country:US
Practice Address - Phone:757-499-2389
Practice Address - Fax:757-499-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000226152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA19330OtherSPECTERA
VA2901OtherDAVIS VISION
VA111179OtherEYEMED VISION
0242110002Medicare NSC
VAT21940Medicare UPIN