Provider Demographics
NPI:1629515630
Name:DAVID K MOORE OD PLLC
Entity Type:Organization
Organization Name:DAVID K MOORE OD PLLC
Other - Org Name:THE EYE CENTER OF RADCLIFF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-351-3937
Mailing Address - Street 1:1165 WALMART WAY
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-1471
Mailing Address - Country:US
Mailing Address - Phone:270-351-3937
Mailing Address - Fax:270-352-2756
Practice Address - Street 1:1165 WALMART WAY
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-1471
Practice Address - Country:US
Practice Address - Phone:270-351-3937
Practice Address - Fax:270-352-2756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-28
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1206DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty