Provider Demographics
NPI:1932101441
Name:MOORE, MORGAN B (OD)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:B
Last Name:MOORE
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 1:902 W KRAMER RD
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354-2640
Mailing Address - Country:US
Mailing Address - Phone:940-569-4131
Mailing Address - Fax:940-569-4648
Practice Address - Street 1:902 W KRAMER RD
Practice Address - Street 2:
Practice Address - City:BURKBURNETT
Practice Address - State:TX
Practice Address - Zip Code:76354-2640
Practice Address - Country:US
Practice Address - Phone:940-569-4131
Practice Address - Fax:940-569-4648
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2859TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E12AMedicare ID - Type Unspecified
TXT14902Medicare UPIN