Nicole R. Moffett OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

TA 1223 Issued in MD

Legal business name

NICOLE R. MOFFETT OD PA

Practice address

2365 Crain Hwy
Waldorf, MD 20601-3167

Phone

(301) 932-9408

NPI assigned

Sep 27, 2015

Last updated

Sep 27, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Nicole Renee Moffett, O.D.NPI 1366574808

Title

Optometrist

Phone

(301) 627-5090

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Nicole Moffett of Optometry Other name

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Locations

Practitioners 1

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.

• Nicole Renee Moffett, O.D.

  • Optometrist
  • Waldorf, MD
  • NPI 1366574808
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1443312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443312000000",
    "number": "1881064319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 451",
            "city": "CHELTENHAM",
            "state": "MD",
            "postal_code": "206230451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2365 CRAIN HWY",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206013167",
            "telephone_number": "301-932-9408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICOLE R. MOFFETT OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-27",
        "last_updated": "2015-09-27",
        "status": "A",
        "authorized_official_last_name": "MOFFETT",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "301-627-5090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA 1223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4463081 00",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Nicole Moffett of Optometry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Optometrist in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Optometrist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2015; 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.