Tiffany Moore, O.D. Inc, a Professional Optometric Corporation
Organization Active NPI Optometrist · Santa Rosa, CA
NPI 1578090981 · NPPES record last updated Aug 29, 2017
Key facts
- NPI
- 1578090981
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 15230 (CA)
- Legal business name
- TIFFANY MOORE, O.D. INC, A PROFESSIONAL OPTOMETRIC CORPORATION
- Practice address
- 800 4TH St
Santa Rosa, CA 95404-4505 - Phone
- (707) 542-1554
- Fax
- (707) 542-1252
- NPI assigned
- May 16, 2017
- Organization subpart
- No
Authorized official
- Name
- Dr. Tiffany Moore, OD
- Title
- Owner
- Phone
- (707) 542-1554
Practitioners 8
-
Kristen Glasgow, O.D.
-
Tiffany Louise Moore, O.D.
-
Margot Shipley, O.D.
-
Bruce P Abramson, O.D.
-
Karin N Boehm, O.D.
-
Alice Chiang, MD
-
Richard David Jones, O.D., F.A.A.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171031001553 | CA | Part B Supplier - Other | 2163795923 |
Receives reassigned benefits from 4 practitioners Practice locations: Santa Rosa, CA |
National Provider Directory
Locations
1265 N Dutton Ave
Santa Rosa, CA 95401
Phone (707) 526-2027
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 15230 | CA | Yes |
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
- Empire Optometry
Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.