Individual
DR. PAT L MOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
215 E CHESTNUT ST, CORYDON, IN 47112
(812) 738-2278
(812) 738-1167
Mailing address
215 E CHESTNUT ST, CORYDON, IN 47112-1107
(812) 738-2278
(812) 738-1167
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001563A
IN
152W00000X
Optometrist
18001563B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000076009
BCBS PIN
IN
05
—
100153090A
—
IN
01
—
410002883
RR MEDICARE PIN
IN
Enumeration date
05/17/2006
Last updated
05/31/2012
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