Provider Demographics
NPI:1093049298
Name:MOSS, AMBER HIERGESELL (OD)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:HIERGESELL
Last Name:MOSS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:AMBER
Other - Middle Name:HIERGESELL
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:532 HAYWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607
Mailing Address - Country:US
Mailing Address - Phone:864-288-7445
Mailing Address - Fax:864-288-8288
Practice Address - Street 1:532 HAYWOOD ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607
Practice Address - Country:US
Practice Address - Phone:864-288-7445
Practice Address - Fax:864-288-8288
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD15730Medicaid