Provider Demographics
NPI:1942252721
Name:MOORE, WILLIAM H (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:MOORE
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:P.O. BOX 1259
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29021-1259
Mailing Address - Country:US
Mailing Address - Phone:803-713-8350
Mailing Address - Fax:803-713-8433
Practice Address - Street 1:615 LAURENS ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-3523
Practice Address - Country:US
Practice Address - Phone:803-432-9874
Practice Address - Fax:803-432-8441
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0596152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD05965Medicaid
SC410036297OtherRAILROAD MEDICARE PIN
80263OtherMEDCOST
SCT237905362Medicare PIN
80263OtherMEDCOST