Individual
MRS. SANDRA M MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2139 COTTMAN AVE, PHILADELPHIA, PA 19149-1122
(215) 745-1444
(215) 745-1448
Mailing address
2139 COTTMAN AVE, PHILADELPHIA, PA 19149-1122
(215) 745-1444
(215) 745-1448
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG001074
PA
152WC0802X
Corneal and Contact Management Optometrist
OEG001074
PW
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2193348000
INDEPENDENCE BLUE CROSS
PA
Enumeration date
06/06/2006
Last updated
08/27/2010
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