Kim Moyer OD PC
Organization Active NPI Optometrist · Rensselaer, IN
NPI 1336280494 · NPPES record last updated May 25, 2020
Key facts
- NPI
- 1336280494
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 18001961B (IN)
- Legal business name
- KIM MOYER OD PC
- Practice address
- 215 W Kellner Blvd Ste 12
Rensselaer, IN 47978-2665 - Phone
- (219) 866-5722
- NPI assigned
- Feb 10, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Kim E Moyer, OD
- Title
- Owner
- Phone
- (219) 866-5722
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 18001961B | IN | Yes |
Addresses
Primary practice location
215 W Kellner Blvd Ste 12
Rensselaer, IN 47978-2665
Mailing address
215 W Kellner Blvd Ste 12
Rensselaer, IN 47978-2665
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100210730C | Medicaid | IN |
Other providers in Rensselaer, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 25, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.