Broderick Devon Moses, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1383-519T Issued in LA

Practice address

4500 Veterans Memorial Blvd.
Target Optical
Metairie, LA 70006-5330

Phone

(504) 454-3791

Fax

(504) 456-3058

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in LA

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Moses Vision Care LLC

  • Optometrist
  • Metairie, LA
  • NPI 1417146994
  Medicare reassignment Authorized official
• Jesus Vision LLC

  • Optometrist
  • Houston, TX
  • NPI 1144757675
  NPD
• Jason Wonch, O.D. and Associates, a.P.C.

  • Optometrist
  • Lake Charles, LA
  • NPI 1295769008
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1245342898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 VETERANS MEMORIAL BLVD",
            "address_2": "TARGET OPTICAL",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700065330",
            "telephone_number": "504-454-3791",
            "fax_number": "504-456-3058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 VETERANS MEMORIAL BLVD.",
            "address_2": "TARGET OPTICAL",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700065330",
            "telephone_number": "504-454-3791",
            "fax_number": "504-456-3058"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3301 Veterans Memorial Blvd.",
            "address_2": "Macy's inside Lenscrafters",
            "address_purpose": "LOCATION",
            "city": "Metairie",
            "state": "LA",
            "postal_code": "700027657",
            "country_code": "US",
            "telephone_number": "504-838-0081",
            "fax_number": "504-838-0080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOSES",
        "first_name": "BRODERICK",
        "middle_name": "DEVON",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "6684TG",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "LA",
            "license": "1383-519T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF TEXAS: INDIVIDUAL",
            "identifier": "1245342898",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF TEXAS: GROUP",
            "identifier": "1417146994",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1627348",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF TEXAS",
            "identifier": "82393Q",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Morvant'S Surgical Garments
• Morvants Surgical Garments
• Emily Michelle Moseley
• Jennifer Herques Moseley, LCSW
• Moses Vision Care LLC
• Damien Anthony Moses X, BA PSYCHOLOGY
• Jareion Angel Moses
• Tailar B Moses
• Mariana Mosquera, M.ED, NCC, LPC
• Joseph Anthony Moss

• Optometrist in Metairie, LA
• Providers in Metairie, LA by specialty
• Optometrist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.