Active NPI
John Edward Moran, O.D.
- Optometrist
- Dearborn, MI
National Provider Identifier
1023365020
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901002821
- Practice address
- 13530 Michigan Ave
Dearborn, MI 48126-3574 - Phone
- (313) 827-0779
- NPI assigned
- Aug 8, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901002821 | MI | Primary |
Addresses
Primary practice location
13530 Michigan Ave
Dearborn, MI 48126-3574
Mailing address
2974 Syracuse St
Dearborn, MI 48124-3304
Phone (313) 330-1151
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901002821 | MI | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344384000000",
"number": "1023365020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2974 SYRACUSE ST",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481243304",
"telephone_number": "313-330-1151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13530 MICHIGAN AVE",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481263574",
"telephone_number": "313-827-0779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORAN",
"first_name": "JOHN",
"middle_name": "EDWARD",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-08-08",
"last_updated": "2012-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901002821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.