Provider Demographics
NPI:1952369282
Name:MOODY, D PENN (OD)
Entity Type:Individual
Prefix:DR
First Name:D
Middle Name:PENN
Last Name:MOODY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8936 SOUTHPOINTE DR
Mailing Address - Street 2:SUITE C-5
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-7507
Mailing Address - Country:US
Mailing Address - Phone:317-883-1122
Mailing Address - Fax:317-883-1139
Practice Address - Street 1:8936 SOUTHPOINTE DR
Practice Address - Street 2:SUITE C-5
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-7507
Practice Address - Country:US
Practice Address - Phone:317-883-1122
Practice Address - Fax:317-883-1139
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001808B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T34941Medicare UPIN
230910Medicare ID - Type Unspecified