Provider Demographics
NPI:1790809226
Name:GREGORY S MOORE OD PC
Entity Type:Organization
Organization Name:GREGORY S MOORE OD PC
Other - Org Name:MOORE EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-768-7902
Mailing Address - Street 1:2335 CHESTERFIELD AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1066
Mailing Address - Country:US
Mailing Address - Phone:304-768-7902
Mailing Address - Fax:304-768-7932
Practice Address - Street 1:2335 CHESTERFIELD AVE STE 303
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1066
Practice Address - Country:US
Practice Address - Phone:304-768-7902
Practice Address - Fax:304-768-7932
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREGORY S. MOORE OD PC DBA MOORE EYE CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV843OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty