Provider Demographics
NPI:1922868751
Name:MOORE, EMILY MARIE (OD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:MOORE
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 1:55 RAINBOW LN
Mailing Address - Street 2:
Mailing Address - City:MORRISDALE
Mailing Address - State:PA
Mailing Address - Zip Code:16858-8865
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 RAINBOW LN
Practice Address - Street 2:
Practice Address - City:MORRISDALE
Practice Address - State:PA
Practice Address - Zip Code:16858-8865
Practice Address - Country:US
Practice Address - Phone:814-441-6023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG004141152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist