Organization
EVELYN MARIE MOORE O.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EVELYN MARIE MOORE O.D. (PRESIDENT OF CORPORATION)
(217) 351-4106
Entity
Organization
Contact information
Practice address
501 S MATTIS AVE, SUITE B, CHAMPAIGN, IL 61821-4274
(217) 351-4106
(217) 351-4052
Mailing address
501 S MATTIS AVE, SUITE B, CHAMPAIGN, IL 61821-4274
(217) 351-4106
(217) 351-4052
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
046006881
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497826655
—
IL
Enumeration date
03/29/2011
Last updated
03/29/2011
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