Individual
JEFFREY MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4455 CLEVELAND AVE STE A, FORT MYERS, FL 33901-9057
(239) 939-5393
Mailing address
5142 SW 3RD AVE, CAPE CORAL, FL 33914-7119
(239) 549-2506
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC 1680
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78430300
—
FL
Enumeration date
07/12/2006
Last updated
12/26/2019
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