Individual
DR. STEPHEN L MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1322 LOCUST AVE, FAIRMONT, WV 26554-1436
(304) 366-0700
(304) 367-8766
Mailing address
PO BOX 1112, FAIRMONT, WV 26555-1112
(304) 366-0700
(304) 367-8766
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
783D
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004613017
AETNA
WV
01
—
001718661
MT STATE BC/BS
WV
05
—
0150898000
—
WV
01
—
227498
OPTIMUM CHOICE
WV
01
—
410025059
RR MEDICARE
WV
01
—
505817
NATIONAL CAPITAL PPO
WV
01
—
FQ783
HEALTH PLAN
WV
01
—
V27522
WV WORKER'S COMP
WV
Enumeration date
07/07/2006
Last updated
04/10/2018
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