Provider Demographics
NPI:1295112100
Name:MICHAEL J MOSES O.D., INC
Entity type:Organization
Organization Name:MICHAEL J MOSES O.D., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:254-289-5197
Mailing Address - Street 1:4104 E STAN SCHLUETER LOOP
Mailing Address - Street 2:6
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-7872
Mailing Address - Country:US
Mailing Address - Phone:254-690-8999
Mailing Address - Fax:
Practice Address - Street 1:4104 E STAN SCHLUETER LOOP
Practice Address - Street 2:6
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-7872
Practice Address - Country:US
Practice Address - Phone:254-690-8999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4520-TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U62177Medicare UPIN
00E19VMedicare PIN