Provider Demographics
NPI:1578863718
Name:MOMA, NENE M (OD)
Entity Type:Individual
Prefix:DR
First Name:NENE
Middle Name:M
Last Name:MOMA
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:1522 BLACK HICKORY PL
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3214
Mailing Address - Country:US
Mailing Address - Phone:404-271-8984
Mailing Address - Fax:770-381-3935
Practice Address - Street 1:1522 BLACK HICKORY PL
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3214
Practice Address - Country:US
Practice Address - Phone:404-271-8984
Practice Address - Fax:770-381-3935
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAOPT002619152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist