1841329893 NPI number — MOOREFOCUSED LLC

Table of content: (NPI 1841329893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841329893 NPI number — MOOREFOCUSED LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOOREFOCUSED LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841329893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 W BOSCAWEN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22601-4118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-667-2220
Provider Business Mailing Address Fax Number:
540-722-3144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#4 PENDLETON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLEBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20117-0786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-687-3133
Provider Business Practice Location Address Fax Number:
540-687-3133
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
OWNER OPTICIAN
Authorized Official Telephone Number:
540-667-2220

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  1101001190 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 50556 . This is a "DAVIS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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