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Organization

CROSSTOWN EYECARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. D. PENN MOODY O.D. (MEMBER)
(765) 342-5497
Entity
Organization

Contact information

Practice address
990 S MARION ST, MARTINSVILLE, IN 46151-2438
(765) 342-5497
(765) 349-1922
Mailing address
990 S MARION ST, MARTINSVILLE, IN 46151-2438
(765) 342-5497
(765) 349-1922

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001808B
IN
332H00000X
Eyewear Supplier

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
02875
SPECTERA
IN
05
23091
IN
01
4434
DAVIS VISION
IN
01
7653425497
VISION SERVICE PLAN
IN
01
IN1808
EYEMED
IN
Enumeration date
03/12/2008
Last updated
12/14/2010
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