Individual
DR. BENJAMIN ALAN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
401 W MAIN ST, SUITE A, JOHN DAY, OR 97845-1075
(541) 575-1819
(541) 575-0965
Mailing address
401 W MAIN ST, SUITE A, JOHN DAY, OR 97845-1075
(541) 575-1819
(541) 575-0965
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3268ATI
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023687
—
OR
Enumeration date
10/16/2007
Last updated
01/26/2009
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