Tiffany Louise Moore, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

15230 Issued in CA

Practice address

800 4TH St
Santa Rosa, CA 95404-4505

Phone

(707) 542-1554

NPI assigned

Oct 18, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Optometry

Education

Pacific University - College of Optometry, 2015

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

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.

• Tiffany Moore, O.D. Inc, a Professional Optometric Corporation

  • Optometrist
  • Santa Rosa, CA
  • NPI 1578090981

  CA, Optometrist

  Medicare reassignment NPD Authorized official
• R. David Jones, O.D.

  • Optometrist
  • Santa Rosa, CA
  • NPI 1376771808
  NPD (past)

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

{
    "created_epoch": "1350518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433894400000",
    "number": "1417200288",
    "addresses": [
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "2024 MONTECITO AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 4TH ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044505",
            "telephone_number": "707-542-1554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "TIFFANY",
        "middle_name": "LOUISE",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-18",
        "last_updated": "2015-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "15230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carley Moore
• Estefani Moore
• Michael Braxton Moore, RPH
• Nikki Moore
• Reece Evan Moore, SUD COUNSELOR
• Tina R Moore, MSW, LCSW
• Jinny Abigail Mora Botello
• Vicente Mora Guzman, AMFT
• Paola Ruiz Mora
• Eileen Morabito

• All providers in Santa Rosa, CA
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.