Organization Name: | EVELYN MARIE MOORE O.D., P.C. |
NPI Number: | 1750670808 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | EVELYN MARIE MOORE (PRESIDENT OF CORPORATION) |
Mailing Address: | 501 S Mattis Ave Suite B Champaign |
State: | IL US |
Postal Code: | 618214274 |
Phone Number: | 2173514106 |
Fax Number: | 2173514052 |
NPI Enumeration Date: | 03/29/2011 |
NPI Last Update Date: | 03/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | 046006881 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |