Individual
DR. ALVARO JORGE MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
598 E CENTRAL AVE, PETAL, MS 39465-2957
(601) 450-3937
(601) 450-3937
Mailing address
598 E CENTRAL AVE, PETAL, MS 39465-2957
(601) 549-1553
(601) 450-3937
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
610
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005161245
AETNA
MS
05
—
00880076
—
MS
05
—
08637209
—
MS
Enumeration date
11/01/2006
Last updated
08/30/2020
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