Provider Demographics
NPI:1902231632
Name:GREGORY SCOTT MOORE OD PLLC
Entity Type:Organization
Organization Name:GREGORY SCOTT MOORE OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-205-5844
Mailing Address - Street 1:PO BOX 11846
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25339-1846
Mailing Address - Country:US
Mailing Address - Phone:304-205-5844
Mailing Address - Fax:304-205-5867
Practice Address - Street 1:301 RHL BLVD.
Practice Address - Street 2:STE 2020
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-8291
Practice Address - Country:US
Practice Address - Phone:304-205-5844
Practice Address - Fax:304-205-5867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty