Provider Demographics
NPI:1013135821
Name:MOORE EYE FOUNDATION
Entity Type:Organization
Organization Name:MOORE EYE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LOW VISION SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRILLIANT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-544-0500
Mailing Address - Street 1:100 W SPROUL RD
Mailing Address - Street 2:HEALTHPLEX PAVILION II - SUITE 125
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2033
Mailing Address - Country:US
Mailing Address - Phone:610-544-0500
Mailing Address - Fax:610-690-1659
Practice Address - Street 1:100 W SPROUL RD
Practice Address - Street 2:SUITE 125
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2033
Practice Address - Country:US
Practice Address - Phone:610-544-0500
Practice Address - Fax:610-690-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherTIN
PA=========OtherTIN