Organization
MOSES VISION CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRODERICK MOSES O.D. (OPTOMETRIST)
(832) 859-2394
Entity
Organization
Contact information
Practice address
4500 VETERANS MEMORIAL BLVD, METAIRIE, LA 70006-5330
(504) 454-3791
(504) 456-3058
Mailing address
4500 VETERANS MEMORIAL BLVD, METAIRIE, LA 70006-5330
(504) 454-3791
(504) 456-3058
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6684TG
TX
261Q00000X
Clinic/Center
1383-519T
LA
261Q00000X
Clinic/Center
6684TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417146994
BLUE CROSS BLUE SHIELD OF TEXAS
TX
05
—
1627348
—
LA
Enumeration date
10/19/2007
Last updated
02/19/2019
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