Provider Demographics
NPI:1669030961
Name:NICHOLE R. MOOS, O.D. INC
Entity Type:Organization
Organization Name:NICHOLE R. MOOS, O.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-442-4927
Mailing Address - Street 1:1009 12TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-3901
Mailing Address - Country:US
Mailing Address - Phone:916-442-4927
Mailing Address - Fax:916-442-4928
Practice Address - Street 1:1009 12TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-3901
Practice Address - Country:US
Practice Address - Phone:916-442-4927
Practice Address - Fax:916-442-4928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty