| Doctor Name: | DR. MARK A MOEN |
| NPI Number: | 1124124623 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | OD |
| License Number: | 441 |
| Business Practice Address: | 404 Hwy 2 East Devils Lake, ND - 583010130 |
| Business Phone Number: | 7016624085 |
| Business Fax Number: | 7016626685 |
| Mailing Address: | Po Box 130, DEVILS LAKE |
| State: | ND |
| Postal Code: | 583010130 |
| Phone Number: | 7016624085 |
| Fax Number: | 7016626685 |
| NPI Enumeration Date: | 09/15/2006 |
| NPI Last Update Date: | 05/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 152WC0802X |
| License Number: | 441 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ND |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Optometrist |
| Taxonomy Specialization: | Corneal and Contact Management |
| Taxonomy Definition: | The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea |