Individual
DR. MICHAEL R MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
7935 N BROADWAY ST, KANSAS CITY, MO 64118-1410
(816) 682-8504
Mailing address
7935 N BROADWAY ST, KANSAS CITY, MO 64118-1410
(816) 682-8504
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1661
KS
152W00000X
Optometrist
Primary
2001018944
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200267160
—
KS
05
—
315398404
—
MO
Enumeration date
07/11/2006
Last updated
07/08/2007
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