Dale J Moser

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901003085 Issued in MI

Legal business name

DALE J MOSER

Practice address

1520 N McEwan St
Clare, MI 48617

Phone

(989) 386-2020

Fax

(989) 386-7308

NPI assigned

Jan 10, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dale J Moser

Title

Owner

Phone

(989) 386-2020

Specialties & licenses 3

Addresses

Other identifiers 5

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333411200000",
    "number": "1053615708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 N MCEWAN ST # B",
            "city": "CLARE",
            "state": "MI",
            "postal_code": "486171196",
            "telephone_number": "989-386-2020",
            "fax_number": "989-386-7308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 N MCEWAN ST",
            "city": "CLARE",
            "state": "MI",
            "postal_code": "48617",
            "telephone_number": "989-386-2020",
            "fax_number": "989-386-7308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALE J MOSER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-10",
        "last_updated": "2012-04-03",
        "status": "A",
        "authorized_official_last_name": "MOSER",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-386-2020"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003085",
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "MI",
            "license": "003085",
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "MI",
            "license": "004640",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-INSPECIFIED",
            "identifier": "0A86500",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIED",
            "identifier": "900A86500",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1769910",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1908862",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "410008233",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Clare, MI
• Providers in Clare, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 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.

Verify at the official NPI Registry.