Active NPI
Robert A Moore, OD
- Optometrist
- El Dorado, KS
National Provider Identifier
1104892983
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 12632
- Practice address
- 1400 W Central Ave
El Dorado, KS 67042-2201 - Phone
- (316) 320-2200
- Fax
- (316) 321-0430
- NPI assigned
- Feb 23, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 12632 | KS | Primary |
Addresses
Primary practice location
1400 W Central Ave
El Dorado, KS 67042-2201
Mailing address
1851 N Webb Rd
Attn FLR2
Wichita, KS 67206-3413
Phone (316) 636-2010
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100219320B | Medicaid | KS | |
| 410029647 | Other | KS | RAILROAD MEDICARE |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12632 | KS | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386288000000",
"number": "1104892983",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1851 N WEBB RD",
"address_2": "ATTN FLR2",
"city": "WICHITA",
"state": "KS",
"postal_code": "672063413",
"telephone_number": "316-636-2010",
"fax_number": "316-858-3830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 W CENTRAL AVE",
"city": "EL DORADO",
"state": "KS",
"postal_code": "670422201",
"telephone_number": "316-320-2200",
"fax_number": "316-321-0430"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "ROBERT",
"middle_name": "A",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-23",
"last_updated": "2013-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "KS",
"license": "12632",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100219320B",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "410029647",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in El Dorado, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.