Mark Edward Moore, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618001005 Issued in VA

Practice address

3333 S Crater Rd Ste 2D
Petersburg, VA 23805-9276

Phone

(804) 732-3937

Fax

(804) 733-6005

NPI assigned

Sep 25, 2006

Last updated

Jun 29, 2017By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Enrolled in VA

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

Southern College of Optometry, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Crater Vision Inc

  • Optometrist
  • Petersburg, VA
  • NPI 1497935829
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1498694400000",
    "number": "1730289935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 S CRATER RD STE 2D",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059276",
            "telephone_number": "804-732-3937",
            "fax_number": "804-733-6005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 S CRATER RD STE 2D",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059276",
            "telephone_number": "804-732-3937",
            "fax_number": "804-733-6005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARK",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2017-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618001005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "080634",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009235221",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Raj K Mishra, M.D.
• Mission of Love Corp. (Advanced, Basic and Complex Home Care (ABC Home Care))
• Britney Mitchell, LPC, LSATP
• Kathryn Pearman Mock, LPTA
• Motsumi Moja, MD
• Mooving You Along Transportation Service, LLC
• Diana Morales
• David C Morgan
• Lisa Dollene Morgan, CSAC-S, BS, QMHP
• Melanie Morgan, LDO

• Optometrist in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Optometrist in Virginia

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