Provider Demographics
NPI:1780377069
Name:MOORE, ROGER JAMES
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:JAMES
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 VALLEY GATE DR
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-2745
Mailing Address - Country:US
Mailing Address - Phone:215-488-9030
Mailing Address - Fax:215-343-2425
Practice Address - Street 1:299 VALLEY GATE DR
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-2745
Practice Address - Country:US
Practice Address - Phone:215-488-9030
Practice Address - Fax:215-343-2425
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA242061156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician