Provider Demographics
NPI:1710177274
Name:MOORE, DAVID A (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:MOORE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:261 N HARBIN DR
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-2814
Mailing Address - Country:US
Mailing Address - Phone:254-968-2345
Mailing Address - Fax:254-968-2352
Practice Address - Street 1:261 N HARBIN DR
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-2814
Practice Address - Country:US
Practice Address - Phone:254-968-2345
Practice Address - Fax:254-968-2352
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7091T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F21030Medicare PIN