Provider Demographics
NPI:1821253816
Name:MOORE, MARCIA MAE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:MAE
Last Name:MOORE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5001 BISSONNET ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4025
Mailing Address - Country:US
Mailing Address - Phone:713-664-8087
Mailing Address - Fax:713-664-8078
Practice Address - Street 1:5001 BISSONNET ST
Practice Address - Street 2:SUITE 107
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4025
Practice Address - Country:US
Practice Address - Phone:713-664-8087
Practice Address - Fax:713-664-8078
Is Sole Proprietor?:No
Enumeration Date:2008-07-19
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7219TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7219TGOtherTEXAS OPTOMETRY LICENSE
TX8L12661Medicare PIN