Provider Demographics
NPI:1790717866
Name:MOSES, ROBERT JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:MOSES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 E 68TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-3506
Mailing Address - Country:US
Mailing Address - Phone:219-613-1230
Mailing Address - Fax:
Practice Address - Street 1:70 E 68TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-3506
Practice Address - Country:US
Practice Address - Phone:219-736-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003410A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200829100Medicaid
INV10278Medicare UPIN
INP00366788Medicare PIN
IN495250DMedicare PIN
INP00438431Medicare PIN
INP00438433Medicare PIN
IN496000DMedicare PIN
INP00883295Medicare PIN
IN179800DMedicare PIN
IN436640DMedicare PIN