Provider Demographics
NPI:1639582364
Name:MOOR, JASON (OD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:MOOR
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 1:1950 E GREYHOUND PASS
Mailing Address - Street 2:SUITE #2
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-7787
Mailing Address - Country:US
Mailing Address - Phone:317-569-0860
Mailing Address - Fax:
Practice Address - Street 1:1950 E GREYHOUND PASS
Practice Address - Street 2:SUITE #2
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-7787
Practice Address - Country:US
Practice Address - Phone:317-569-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003842A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist