Provider Demographics
NPI:1487850210
Name:MOYER, BREEZY JANE (OD)
Entity type:Individual
Prefix:
First Name:BREEZY
Middle Name:JANE
Last Name:MOYER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 JPM RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9313
Mailing Address - Country:US
Mailing Address - Phone:570-523-3937
Mailing Address - Fax:
Practice Address - Street 1:88 HARDEES DR
Practice Address - Street 2:
Practice Address - City:MIFFLINBURG
Practice Address - State:PA
Practice Address - Zip Code:17844-7062
Practice Address - Country:US
Practice Address - Phone:570-966-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001933152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
50083510OtherCAPITAL BLUE
118325OtherBLUE SHIELD
825611OtherFIRST PRIORITY HEALTH
113532OtherGEISINGER
825611OtherFIRST PRIORITY HEALTH