Provider Demographics
NPI:1700834728
Name:MOORE, JAMES STEPHEN (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STEPHEN
Last Name:MOORE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:421 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2709
Mailing Address - Country:US
Mailing Address - Phone:601-249-0083
Mailing Address - Fax:601-249-0309
Practice Address - Street 1:421 MARION AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2709
Practice Address - Country:US
Practice Address - Phone:601-249-0083
Practice Address - Fax:601-249-0309
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS566152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01729377Medicaid
MS5627310001OtherMEDICARE DMEPOS SUPPLIER
MS5627310001OtherMEDICARE DMEPOS SUPPLIER
MS5627310001OtherMEDICARE DMEPOS SUPPLIER
MSU25382Medicare UPIN