| Organization Name: | MOORE FAMILY EYECARE, LLC |
| NPI Number: | 1053631770 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DOUGLAS LORAN MOORE (MEMBER) |
| Mailing Address: | 2130 N Main Ave Ste 4 Mountain Grove |
| State: | MO US |
| Postal Code: | 657111451 |
| Phone Number: | 4179263937 |
| Fax Number: | 4179263952 |
| NPI Enumeration Date: | 06/04/2010 |
| NPI Last Update Date: | 09/23/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | T03463 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |