NPIMap

Organization Active NPI

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

Doing business as Empire Optometry

  • Optometrist
  • Santa Rosa, CA
National Provider Identifier
1578090981
Registry record updated Aug 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
15230 Issued in CA
Legal business name
TIFFANY MOORE, O.D. INC, A PROFESSIONAL OPTOMETRIC CORPORATION
Doing business as
Empire Optometry
Practice address
800 4TH St
Santa Rosa, CA 95404-4505
Phone
(707) 542-1554
Fax
(707) 542-1252
NPI assigned
May 16, 2017
Last updated
Aug 29, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2017

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

Authorized official

Name
Dr. Tiffany Moore, ODNPI 1417200288
Title
Owner
Phone
(707) 542-1554

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 15230 CA Primary

Addresses

Primary practice location

800 4TH St
Santa Rosa, CA 95404-4505

Mailing address

800 4TH St
Santa Rosa, CA 95404-4505
Phone (707) 542-1554

Other names 1

  • Empire Optometry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171031001553 CA Part B Supplier - Other 2163795923 Receives reassigned benefits from 4 practitioners
Practice locations: Santa Rosa, CA

National Provider Directory

National Provider Directory

Locations

1265 N Dutton Ave
Santa Rosa, CA 95401
Phone (707) 526-2027

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1494892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503964800000",
    "number": "1578090981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 4TH ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044505",
            "telephone_number": "707-542-1554",
            "fax_number": "707-542-1252"
        },
        {
            "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",
            "fax_number": "707-542-1252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIFFANY MOORE, O.D. INC, A PROFESSIONAL OPTOMETRIC CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-16",
        "last_updated": "2017-08-29",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-542-1554",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "15230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Empire Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.