Provider Demographics
NPI:1578741724
Name:PAUL A. MOCCIA, O.D., P.A.
Entity Type:Organization
Organization Name:PAUL A. MOCCIA, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOCCIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:913-367-9270
Mailing Address - Street 1:1103 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-3109
Mailing Address - Country:US
Mailing Address - Phone:913-367-9270
Mailing Address - Fax:
Practice Address - Street 1:1103 S 4TH ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-3109
Practice Address - Country:US
Practice Address - Phone:913-367-9270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2010-09-30
Deactivation Date:2008-07-28
Deactivation Code:
Reactivation Date:2010-09-21
Provider Licenses
StateLicense IDTaxonomies
KS1286-3152W00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1286-3OtherSTATE LICENSE
KS100218590BMedicaid
MOTO2769OtherSTATE LICENSE
MO312562341Medicaid
MO0000178CMedicare PIN
KS049823Medicare PIN
KS100218590BMedicaid
MO312562341Medicaid