Individual
JESSICA DYAN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
210 N SAUNDERS AVE, SUTTON, NE 68979-2511
(402) 366-6966
Mailing address
PO BOX 75, SUTTON, NE 68979-0075
(402) 366-6966
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1183
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0183380002
DMERC
NE
01
—
22-00509
UNITED HEALTH CARE
NE
01
—
36383
BLUE CROSS BLUE SHIELD
NE
01
—
410048038
RAILROAD MEDICARE
NE
Enumeration date
10/04/2005
Last updated
07/26/2011
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