Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 002648 | CT |
Y | 152W00000X | Optometrist | 3600 | MN |
NPI | 1003036427 |
---|---|
Provider Name | Dr. Jodi M. Moore-Weiss |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 11/08/2020 |