Provider Demographics
NPI:1184788713
Name:MOY, ANNE DMU (OD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:DMU
Last Name:MOY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 BANCROFT EXT
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-4303
Mailing Address - Country:US
Mailing Address - Phone:510-643-2020
Mailing Address - Fax:510-642-9422
Practice Address - Street 1:2222 BANCROFT EXT
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4303
Practice Address - Country:US
Practice Address - Phone:510-643-2020
Practice Address - Fax:510-642-9422
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10908TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10908TLGOtherLICENSE NUMBER
CASD0109080OtherPROVIDER IDENTIFICATION
CASD0109080OtherPROVIDER IDENTIFICATION
CAMM0649888OtherDEA NUMBER
CAU89503Medicare UPIN