Provider Demographics
NPI:1689873820
Name:MOORE EYE CARE LLC
Entity Type:Organization
Organization Name:MOORE EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-583-2020
Mailing Address - Street 1:683 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-6662
Mailing Address - Country:US
Mailing Address - Phone:860-583-2020
Mailing Address - Fax:860-582-8283
Practice Address - Street 1:683 BROAD ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6662
Practice Address - Country:US
Practice Address - Phone:860-583-2020
Practice Address - Fax:860-582-8283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT090000683CT01OtherBLUECROSS
CT004397007Medicaid
CT090000803CT01OtherBLUECROSS
CT090002482CT01OtherBLUECROSS
CTC01127Medicare PIN
CT004397007Medicaid