Organization
MICHAEL D MOORE OD PS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL D MOORE OD (OWNER/PRESIDENT)
(360) 357-7899
Entity
Organization
Contact information
Practice address
2600 MARTIN WAY E, STE C, OLYMPIA, WA 98506-4974
(360) 357-7899
(360) 357-6495
Mailing address
2600 MARTIN WAY E, STE C, OLYMPIA, WA 98506-4974
(360) 357-7899
(360) 357-6495
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1010
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0149388
L & I
WA
01
—
1770560708
NPI
—
05
—
2631703
—
WA
Enumeration date
04/24/2008
Last updated
03/07/2023
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