Individual
DR. EVELYN MARIE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2032 N PROSPECT AVE, CHAMPAIGN, IL 61822-1240
(217) 954-1085
(217) 607-5457
Mailing address
2032 N PROSPECT AVE, CHAMPAIGN, IL 61822-1240
(217) 954-1085
(217) 607-5457
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046.006881
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001084006
BLUE CROSS BLUE SHIELD
IL
Enumeration date
11/10/2006
Last updated
12/30/2016
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