Individual
DR. LEE RICHARD MOORE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
311 PROSPECT AVE, CHARLES TOWN, WV 25414-1137
(304) 725-1411
(304) 725-1412
Mailing address
311 PROSPECT AVE, CHARLES TOWN, WV 25414-1137
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
728OD
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001709879
BLUE CROSS BLUE SHIELD
WV
01
—
2173688
MAMSI
WV
01
—
2716372
UNITED HEALTH CARE
WV
01
—
4534560
AETNA
WV
01
—
550624322
TAX ID
WV
01
—
550624322001
INFORMED
WV
01
—
550624322AB
WELLS FARGO
WV
Enumeration date
10/24/2006
Last updated
04/23/2008
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