Allan William Moore, OD
Individual provider Active NPI Optometrist · Manchester, GA
NPI 1942296017 · NPPES record last updated Aug 5, 2021
Key facts
- NPI
- 1942296017
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 888T (GA)
- Practice address
- 1180 Warm Springs Hwy
Manchester, GA 31816-1166 - Phone
- (706) 846-2131
- Fax
- (706) 846-3517
- NPI assigned
- Sep 23, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 10
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern College of Optometry, 1979
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Myeyedr Optometry of Georgia, LLC
Practice addresses (Care Compare)
1180 Warm Springs Hwy
Manchester, GA 31816-1166
Phone (706) 846-2131
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 11 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Warm Spring Medical Center |
Rural health clinic | Corporate Officer (100%) Corporate Director (100%) Operational/Managerial Control (100%) |
Aug 31, 2019 Aug 31, 2019 Aug 31, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101029000860 | GA | Practitioner - Optometry | 6709090111 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 888T | GA | MD | Optometrist |
| 888 | GA | MD | Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Myeyedr Optometry of Georgia, LLC | Optometrist | Current | Accepting new patients |
| Myeyedr Optometry of Georgia, LLC | Optometrist | Current |
Accepting new patients |
| Myeyedr Optometry of Georgia, LLC | Optometrist | Current |
Accepting new patients |
| Myeyedr Optometry of Georgia, LLC | Optometrist | Past | Accepting new patients |
Locations
4875 Altama Ave
Brunswick, GA 31520
Phone (912) 554-0010
6490 Veterans Pkwy
Columbus, GA 31909
Phone (706) 653-6200
1180 Warm Springs Hwy
Manchester, GA 31816
Phone (706) 846-2131
8614 Westwood Center Dr
Fl 9
Vienna, VA 22182
1950 Old Gallows Rd
Ste 520
Vienna, VA 22182
Interoperability endpoints
- amoore022211@myeyedr.emadirect.md
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 888T | GA | Yes |
Addresses
Primary practice location
1180 Warm Springs Hwy
Manchester, GA 31816-1166
Mailing address
1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 162199146A | Medicaid | GA | |
| 4811300001 | Other | GA | PALMETTO GBA NSC |
Other providers in Manchester, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 5, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.