Bruce Allen Moen, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

429 Issued in ND

Practice address

1100 31St Ave SW
Suite 2
Minot, ND 58701-2007

Phone

(701) 837-0022

Fax

(701) 839-2005

NPI assigned

Jul 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191542400000",
    "number": "1588694194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 31ST AVE SW",
            "address_2": "SUITE 2",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587012007",
            "telephone_number": "701-837-0022",
            "fax_number": "701-839-2005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 31ST AVE SW",
            "address_2": "SUITE 2",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587012007",
            "telephone_number": "701-837-0022",
            "fax_number": "701-839-2005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOEN",
        "first_name": "BRUCE",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2007-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ND",
            "license": "429",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60328",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Minot, ND
• Providers in Minot, ND by specialty
• Optometrist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2007; 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.