Individual
ROGER MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
14 CHURCH HILL RD, NEWTOWN, CT 06470-1640
(203) 426-2727
(203) 426-5113
Mailing address
14 CHURCH HILL RD, NEWTOWN, CT 06470-1640
(203) 426-2727
(203) 426-5113
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
950
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004067195
—
CT
01
—
0123880001
MEDICARE - DME
CT
01
—
090000950CT01
ANTHEM BC
—
01
—
4321240
AETNA
—
01
—
P620522
OXFORD
CT
Enumeration date
06/10/2005
Last updated
08/06/2012
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