Individual
DR. MARK EDWARD MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3333 S CRATER RD STE 2D, PETERSBURG, VA 23805-9276
(804) 732-3937
(804) 733-6005
Mailing address
3333 S CRATER RD STE 2D, PETERSBURG, VA 23805-9276
(804) 732-3937
(804) 733-6005
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618001005
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009235221
—
VA
01
—
080634
BLUE CROSS
VA
Enumeration date
09/25/2006
Last updated
06/29/2017
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