Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1922 | AZ |
NPI | 1013330745 |
---|---|
Provider Name | Dr. Anna L.o. Moore |
First Address | Sierra Vista, AZ 85635-6358 |
Second Address | Goodyear, AZ 85395-2049 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2014 |
Last Update Date | 01/04/2014 |