Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | OPC1170 | FL |
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPC1170 | FL |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | OPC1170 | FL |
N | 152WS0006X | Sports Vision | OPC1170 | FL |
N | 152WV0400X | Optomitrist - Vision Therapist | OPC1170 | FL |
N | 152WX0102X | Occupational Vision | OPC1170 | FL |
NPI | 1104846187 |
---|---|
Provider Name | Dr. Marshall Norman Moss |
First Address | Miami, FL 33162-2639 |
Second Address | North Miami Beach, FL 33162-4017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 21/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
084858100 | (05) | FL |
T93845 | (02) | FL |