Provider Demographics
NPI:1619946886
Name:MOORE, WARREN HAMPTON (OD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:HAMPTON
Last Name:MOORE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:WARREN
Other - Middle Name:HAMPTON
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1593 DARBY DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-2746
Mailing Address - Country:US
Mailing Address - Phone:256-767-5522
Mailing Address - Fax:256-767-6114
Practice Address - Street 1:1593 DARBY DRIVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5716
Practice Address - Country:US
Practice Address - Phone:256-767-5522
Practice Address - Fax:256-767-6114
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS614TA062152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51529760OtherBLUE CROSS BLUE SHIELD
AL051529760OtherMEDICARE