Provider Demographics
NPI:1912978388
Name:MORAN, RAMON JR (OD, PA)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:
Last Name:MORAN
Suffix:JR
Gender:M
Credentials:OD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15332 NW 79TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5808
Mailing Address - Country:US
Mailing Address - Phone:305-821-0304
Mailing Address - Fax:305-558-0641
Practice Address - Street 1:15332 NW 79TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5808
Practice Address - Country:US
Practice Address - Phone:305-821-0304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL0864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19409Medicare PIN