Individual provider Active NPI

William Moscow, O.D.

  • Optometrist
  • Roswell, GA
National Provider Identifier
1144390600
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
861-T Issued in GA
Practice address
1190 Grimes Bridge Rd
Roswell, GA 30075-3930
Phone
(770) 992-7620
Fax
(770) 992-8262
NPI assigned
Nov 9, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 861-T GA Primary

Addresses

Primary practice location

1190 Grimes Bridge Rd
Roswell, GA 30075-3930

Mailing address

1190 Grimes Bridge Rd
Roswell, GA 30075-3930
Phone (770) 992-7620

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110311000689 GA Practitioner - Optometry 4082896063 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Roswell Eye Clinic,IncGroup PAC ID 7214119114, 6 clinicians

Practice addresses (Care Compare)

1190 Grimes Bridge Rd
Roswell, GA 30075-3955
Phone (770) 992-7620

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
861-TGAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Roswell Eye Clinic,Inc Optometrist CurrentSince Jul 1, 1966 Accepting new patients

Locations

1190 Grimes Bridge Rd
Roswell, GA 30075
Phone (770) 992-7620

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144390600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1190 GRIMES BRIDGE RD",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300753930",
            "telephone_number": "770-992-7620",
            "fax_number": "770-992-8262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 GRIMES BRIDGE RD",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300753930",
            "telephone_number": "770-992-7620",
            "fax_number": "770-992-8262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSCOW",
        "first_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "861-T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

Verify at the official NPI Registry.