Provider Demographics
NPI:1841417789
Name:CHAD E MOFFITT INC
Entity Type:Organization
Organization Name:CHAD E MOFFITT INC
Other - Org Name:ALVIN OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-585-8453
Mailing Address - Street 1:2625 S LOOP 35
Mailing Address - Street 2:SUITE 161
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-4728
Mailing Address - Country:US
Mailing Address - Phone:281-585-8453
Mailing Address - Fax:281-824-8711
Practice Address - Street 1:2625 S LOOP 35
Practice Address - Street 2:SUITE 161
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-4728
Practice Address - Country:US
Practice Address - Phone:281-585-8453
Practice Address - Fax:281-824-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5433TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4014800001OtherPALMETTO DMERC MEDICARE
TX036840901Medicaid
TX80279QOtherBLUE CROSS BLUE SHIELD
TX4014800001OtherPALMETTO DMERC MEDICARE
TX036840901Medicaid