Provider Demographics
NPI:1255384152
Name:MOSHOS, STAVROULA (OD)
Entity type:Individual
Prefix:DR
First Name:STAVROULA
Middle Name:
Last Name:MOSHOS
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 1:5 GRACE RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2753
Mailing Address - Country:US
Mailing Address - Phone:732-991-4936
Mailing Address - Fax:
Practice Address - Street 1:979 ROUTE 1 SOUTH WALMART VISION CENTER
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902
Practice Address - Country:US
Practice Address - Phone:732-545-0435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00603000152W00000X
NYTUV007016-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist