Individual
JACOB BRADLEY MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 N KEENE ST, SUITE 103, COLUMBIA, MO 65201-8104
(573) 874-2030
(573) 449-0253
Mailing address
500 N KEENE ST, SUITE 103, COLUMBIA, MO 65201-8104
(573) 874-2030
(573) 449-0253
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2021020987
MO
Other
Enumeration date
06/11/2021
Last updated
06/11/2021
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