Provider Demographics
NPI:1013993229
Name:MOSER, P WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:P WAYNE
Middle Name:
Last Name:MOSER
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 1:5811 GLENWOOD AVE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-6260
Mailing Address - Country:US
Mailing Address - Phone:919-781-2116
Mailing Address - Fax:
Practice Address - Street 1:4325 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4532
Practice Address - Country:US
Practice Address - Phone:919-782-4100
Practice Address - Fax:919-787-9573
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1026152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890939Medicaid
NC246411Medicare ID - Type Unspecified
NC890939Medicaid