Jack Moore, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD60240767 Issued in WA

Practice address

3700 Martin Way E
#101
Olympia, WA 98506-5052

Phone

(360) 456-2020

Fax

(360) 438-2577

NPI assigned

Dec 13, 2011

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 MN

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

Illinois College of Optometry at Chicago, 2011

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 and National Provider Directory roles.

• Moore Family Eyecare PLLC

  • Optometrist
  • Saint Paul, MN
  • NPI 1134940505
  Medicare reassignment NPD Authorized official
• Visionworks, Inc

  • Eyewear Supplier
  • Simpsonville, SC
  • NPI 1699571166
  NPD (past)
• Visionworks, Inc.

  • Optometrist
  • Austin, MN
  • NPI 1881962173
  NPD (past)

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

{
    "created_epoch": "1323734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323734400000",
    "number": "1891063236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 MARTIN WAY E",
            "address_2": "#101",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065052",
            "telephone_number": "360-456-2020",
            "fax_number": "360-438-2577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 MARTIN WAY E",
            "address_2": "#101",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065052",
            "telephone_number": "360-456-2020",
            "fax_number": "360-438-2577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-13",
        "last_updated": "2011-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60240767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy E Moore, RN
• Erika J Moore, LMT
• Evelyn Marie Moore
• Hayden Lawrence Moore, PT, DPT
• Henrietta Louise Moore, M.ED,LMFT
• John A Moore
• Kaitlin Masaye Yamane Moore, D.C.
• Kathryn Moore, LMP
• Kristen Marie Moore
• Melody Lynn Moore, PA-C, LCSW

• Optometrist in Olympia, WA
• Providers in Olympia, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2011; 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.