Individual
DR. MARK DOUGLAS MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O. D.
Contact information
Practice address
2020 N TYLER RD STE 124, WICHITA, KS 67212-4916
(316) 729-0083
(316) 729-0052
Mailing address
2020 N TYLER RD STE 124, WICHITA, KS 67212-4916
(316) 729-0083
(316) 729-0052
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1367
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018096
BCBSKS
KS
01
—
049695
BCBSKS
KS
01
—
2531
PHS/PPK
KS
Enumeration date
10/11/2006
Last updated
03/08/2012
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