Provider Demographics
NPI:1952376543
Name:MOORE, CHRISTOPHER DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DAVID
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 1:12 ELAINE CT
Mailing Address - Street 2:
Mailing Address - City:CALIFON
Mailing Address - State:NJ
Mailing Address - Zip Code:07830-3554
Mailing Address - Country:US
Mailing Address - Phone:201-420-9471
Mailing Address - Fax:201-420-9923
Practice Address - Street 1:30 MALL DR W # 103A
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-1615
Practice Address - Country:US
Practice Address - Phone:201-420-9471
Practice Address - Fax:201-420-9923
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4830152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ700347Medicare ID - Type UnspecifiedOPTOMETRIST