Organization
DALE J MOSER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DALE J MOSER (OWNER)
(989) 386-2020
Entity
Organization
Contact information
Practice address
1520 N MCEWAN ST, CLARE, MI 48617
(989) 386-2020
(989) 386-7308
Mailing address
1520 N MCEWAN ST # B, CLARE, MI 48617-1196
(989) 386-2020
(989) 386-7308
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003085
MI
332H00000X
Eyewear Supplier
003085
MI
332H00000X
Eyewear Supplier
004640
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0A86500
MEDICARE ID-INSPECIFIED
MI
05
—
1769910
—
MI
05
—
1908862
—
MI
01
—
410008233
RAIL ROAD MEDICARE
MI
01
—
900A86500
BLUE CROSS BLUE SHIED
MI
Enumeration date
01/10/2011
Last updated
04/03/2012
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