1942224324 NPI number — DR. REBECCA ERIN MOSER O.D.

Table of content: DR. REBECCA ERIN MOSER O.D. (NPI 1942224324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942224324 NPI number — DR. REBECCA ERIN MOSER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSER
Provider First Name:
REBECCA
Provider Middle Name:
ERIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUTSON
Provider Other First Name:
REBECCA
Provider Other Middle Name:
ERIN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942224324
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2783 N SHILOH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72704-6983
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-442-8865
Provider Business Mailing Address Fax Number:
479-442-2678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3318 N. NORTH HILLS BLVD
Provider Second Line Business Practice Location Address:
MCDONALD EYE SERVICES P.A
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-521-2555
Provider Business Practice Location Address Fax Number:
479-521-6761
Provider Enumeration Date:
07/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  6904T , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 2695 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 1531-661T , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 182427801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2317423 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: V10248 . This is a "UPIN" identifier . This identifiers is of the category "OTHER".