Individual
KENNETH R MOULTRIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
600 WASHINGTON ST NW, HUNTSVILLE, AL 35801-4751
(256) 533-6838
(256) 533-1910
Mailing address
15933 CLAYTON RD, SUITE 201, BALLWIN, MO 63011-2172
(636) 200-4393
(636) 527-0766
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S536TA063
AL
Other
Enumeration date
02/03/2006
Last updated
02/02/2017
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