Provider Demographics
NPI:1972502763
Name:MOSER, JAMES H (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:MOSER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5908
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75505-5908
Mailing Address - Country:US
Mailing Address - Phone:903-838-9063
Mailing Address - Fax:903-838-9074
Practice Address - Street 1:4401 GALLERIA OAKS DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4675
Practice Address - Country:US
Practice Address - Phone:903-838-9063
Practice Address - Fax:903-838-9074
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03509TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121658206Medicaid
AR113377722Medicaid
TX1285681304OtherGROUP NPI
AR113377722Medicaid
TX5858490001Medicare NSC
TX121658206Medicaid