Provider Demographics
NPI:1528026309
Name:MOORE VISION INC
Entity Type:Organization
Organization Name:MOORE VISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-249-0083
Mailing Address - Street 1:1722 VETERANS BLVD
Mailing Address - Street 2:STE C2
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2052
Mailing Address - Country:US
Mailing Address - Phone:601-684-4481
Mailing Address - Fax:601-249-0309
Practice Address - Street 1:1722 VETERANS BLVD
Practice Address - Street 2:STE C2
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2052
Practice Address - Country:US
Practice Address - Phone:601-684-4481
Practice Address - Fax:601-249-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS566152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01729377Medicaid
MS5627310001Medicare NSC
CO3484Medicare PIN
MSU25382Medicare UPIN