Blue Moon Optical

Primary specialty

OpticianTaxonomy code 156FX1800X

License

189067 Issued in TX

Legal business name

BLUE MOON OPTICAL

Practice address

121 W San Antonio St
San Marcos, TX 78666-5551

Phone

(805) 710-2445

NPI assigned

Mar 25, 2014

Organization subpart

No

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

Authorized official

Name

Michael Patrick Duffy, DO

Title

Owner

Phone

(805) 710-2445

Specialties & licenses 1

Addresses

Other names 1

• Blue Moon Optical Doing business as

Locations

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

{
    "created_epoch": "1395705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395705600000",
    "number": "1174940464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10800 RIVER PLANTATION DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787471482",
            "telephone_number": "805-710-2445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 W SAN ANTONIO ST",
            "city": "SAN MARCOS",
            "state": "TX",
            "postal_code": "786665551",
            "telephone_number": "805-710-2445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE MOON OPTICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-25",
        "last_updated": "2014-03-25",
        "status": "A",
        "authorized_official_last_name": "DUFFY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "805-710-2445",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "TX",
            "license": "189067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Moon Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optician in San Marcos, TX
• Providers in San Marcos, TX by specialty
• Optician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2014; 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.