Michael D Moore OD PS Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

1010 Issued in WA

Legal business name

MICHAEL D MOORE OD PS INC

Practice address

2600 Martin Way E
Ste C
Olympia, WA 98506-4974

Phone

(360) 357-7899

Fax

(360) 357-6495

NPI assigned

Apr 24, 2008

Organization subpart

No

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

Authorized official

Name

Michael D Moore, OD

Title

Owner/President

Phone

(360) 357-7899

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1326213992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 MARTIN WAY E",
            "address_2": "STE C",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985064974",
            "telephone_number": "360-357-7899",
            "fax_number": "360-357-6495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 MARTIN WAY E",
            "address_2": "STE C",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985064974",
            "telephone_number": "360-357-7899",
            "fax_number": "360-357-6495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL D MOORE OD PS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-24",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "360-357-7899",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "1010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "0149388",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1770560708",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2631703",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amber Marie Meyers
• Sydney An Meyers
• MHG Physician Services - Washington, PLLC
• Jin S Miao, DMD
• Mica Homes
• Michael R Ellen MD PS
• Michael R Kelson, DDS, PLLC
• Michael W. Neely, D.C.
• Gina J Michaelson, L.M.P.
• Michelle Rubbert, PLLC

• Optometrist in Olympia, WA
• Providers in Olympia, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.