Samuel Moon, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

9582T Issued in TX

Practice address

101 N Dale Ave
Stephenville, TX 76401-2832

Phone

(254) 968-4133

Fax

(254) 968-5631

NPI assigned

Aug 15, 2018

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

Medicare fee-for-service enrollment

Enrolled in TX

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

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.

• Samuel Moon

  • Optometrist
  • Granbury, TX
  • NPI 1336851609
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1534291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534291200000",
    "number": "1861972200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 N DALE AVE",
            "city": "STEPHENVILLE",
            "state": "TX",
            "postal_code": "764012832",
            "telephone_number": "254-968-4133",
            "fax_number": "254-968-5631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 N DALE AVE",
            "city": "STEPHENVILLE",
            "state": "TX",
            "postal_code": "764012832",
            "telephone_number": "254-968-4133",
            "fax_number": "254-968-5631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "SAMUEL",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-15",
        "last_updated": "2018-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "9582T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Montgomery, OTR
• Luke Montgomery, ACT, LAT
• Monty Joshua Montgomery
• Casey Montoya
• Monty Banks OD PA
• Abrahia Moore
• David A Moore, O.D.
• Jeffrey Moore, M.D.
• Kimberly Moore
• Morgan Mill Isd

• Optometrist in Stephenville, TX
• Providers in Stephenville, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.