Individual
DR. NICOLE RENEE MOFFETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2365 CRAIN HWY, WALDORF, MD 20601-3167
(301) 932-9408
Mailing address
PO BOX 451, CHELTENHAM, MD 20623-0451
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TA1223
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4463081 00
—
MD
Enumeration date
03/11/2007
Last updated
09/27/2015
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