Individual provider Active NPI

Craig Moss, O.D.

  • Optometrist
  • Eagle, ID
National Provider Identifier
1295115087
Registry record updated Jun 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ODP-100338 Issued in ID
Practice address
408 S Eagle Rd Ste 100
Eagle, ID 83616-6079
Phone
(208) 939-2773
NPI assigned
Jun 5, 2015
Last updated
Jun 5, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 5, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X ODP-100338 ID Primary

Addresses

Primary practice location

408 S Eagle Rd Ste 100
Eagle, ID 83616-6079

Mailing address

3100 S Whitepost Way
Eagle, ID 83616-6705
Phone (208) 985-5550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20150723006944 ID Practitioner - Optometry 8224341037 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eagle Vision One PLLCGroup PAC ID 8921099730, 10 clinicians

Practice addresses (Care Compare)

355 S Eagle Rd
Eagle, ID 83616-5912
Phone (208) 938-2015

4574 N Ten Mile Rd
Suite 100
Meridian, ID 83646-7129
Phone (208) 938-2015

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery32

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ODP-100338IDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eagle Vision One PLLC Optometrist CurrentSince Jun 22, 2015 Accepting new patients

Locations

355 S Eagle Rd
Eagle, ID 83616
Phone (208) 938-2015

408 S Eagle Rd
Ste 100
Eagle, ID 83616
Phone (208) 939-2773

4574 N Ten Mile Rd
Ste 100
Meridian, ID 83646
Phone (208) 938-2015

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": "1433462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433462400000",
    "number": "1295115087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 S WHITEPOST WAY",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166705",
            "telephone_number": "208-985-5550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 S EAGLE RD STE 100",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166079",
            "telephone_number": "208-939-2773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSS",
        "first_name": "CRAIG",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-05",
        "last_updated": "2015-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

Verify at the official NPI Registry.