Individual
CHARLIE JIM MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2481 I 40 W, AMARILLO, TX 79109
(806) 358-2205
(806) 463-2907
Mailing address
2481 I 40 W, AMARILLO, TX 79109
(806) 358-2205
(806) 463-2907
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2740TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1331696-07
—
TX
Enumeration date
05/16/2006
Last updated
07/03/2019
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