Provider Demographics
NPI:1760005375
Name:TRAVIS MOFFATT OD PLLC
Entity Type:Organization
Organization Name:TRAVIS MOFFATT OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOFFATT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-635-4978
Mailing Address - Street 1:18423 FM 1488 RD STE D
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-8512
Mailing Address - Country:US
Mailing Address - Phone:346-386-0100
Mailing Address - Fax:346-386-0109
Practice Address - Street 1:18423 FM 1488 RD STE D
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-8512
Practice Address - Country:US
Practice Address - Phone:346-386-0100
Practice Address - Fax:346-386-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty