Mark D Moore, OD
Individual provider Active NPI Optometrist · Douglas, GA
NPI 1043328800 · NPPES record last updated Mar 20, 2015
Key facts
- NPI
- 1043328800
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- OPT001723 (GA)
- Practice address
- 504 Peterson Ave S
Douglas, GA 31533-5254 - Phone
- (912) 389-1230
- Fax
- (912) 389-1260
- NPI assigned
- Aug 29, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
504 Peterson Ave S
Douglas, GA 31533-5254
Phone (912) 389-1230
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 31 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051005000208 | GA | Practitioner - Optometry | 5092740498 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1723 | GA | MD | Audiologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT001723 | GA | Yes |
Addresses
Primary practice location
504 Peterson Ave S
Douglas, GA 31533-5254
Mailing address
504 Peterson Ave S
Douglas, GA 31533-5254
Phone (912) 389-1230
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 457498953D | Medicaid | GA | |
| GRP7442 | Other | GA | MEDICARE PTAN |
Other providers in Douglas, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 20, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.