# MOSES VISION CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417146994
- **Authorized official:** DR. BRODERICK MOSES O.D. (OPTOMETRIST)
- **Authorized official phone:** (832) 859-2394

## Contact information

- **Practice address:** 4500 VETERANS MEMORIAL BLVD, METAIRIE, LA 70006-5330
- **Practice address phone:** (504) 454-3791
- **Practice address fax:** (504) 456-3058
- **Mailing address:** 4500 VETERANS MEMORIAL BLVD, METAIRIE, LA 70006-5330
- **Mailing address phone:** (504) 454-3791
- **Mailing address fax:** (504) 456-3058

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 6684TG | TX | Yes |
| 261Q00000X | Clinic/Center | 1383-519T | LA | — |
| 261Q00000X | Clinic/Center | 6684TG | TX | — |

## Other

- **Enumeration date:** 10/19/2007
- **Last updated:** 02/19/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1417146994 | BLUE CROSS BLUE SHIELD OF TEXAS | TX |
| 05 | — | 1627348 | — | LA |