Active NPI
Dale J Moser
- Optometrist
- Clare, MI
National Provider Identifier
1972691202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901003085
- Practice address
- 1520 B N McEwan St.
Clare, MI 48617-1116 - Phone
- (989) 386-2020
- Fax
- (989) 386-7308
- NPI assigned
- Oct 11, 2006
- Last updated
- Mar 1, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901003085 | MI | Primary |
Addresses
Primary practice location
1520 B N McEwan St.
Clare, MI 48617-1116
Mailing address
1520 B N McEwan St.
Clare, MI 48617-1116
Phone (989) 386-2020
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0A80041 | Other | MI | BLUECROSS AND BLUE SHIELD OF MICHIGAN |
| 1972691202 | Medicaid | MI | |
| 410008233 | Other | RAIL ROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mid Michigan Family Eye Care PLLC | Optometrist | Past | Accepting new patients |
| Mid Michigan Family Eye Care PLLC | Optometrist | Past | Accepting new patients |
Organizations & group practices 4
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.
-
- Optometrist
- Clare, MI
- NPI 1053615708
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362096000000",
"number": "1972691202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1520 B N MCEWAN ST.",
"city": "CLARE",
"state": "MI",
"postal_code": "486171116",
"telephone_number": "989-386-2020",
"fax_number": "989-386-7308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1520 B N MCEWAN ST.",
"city": "CLARE",
"state": "MI",
"postal_code": "486171116",
"telephone_number": "989-386-2020",
"fax_number": "989-386-7308"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSER",
"first_name": "DALE",
"middle_name": "J",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-11",
"last_updated": "2013-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901003085",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS AND BLUE SHIELD OF MICHIGAN",
"identifier": "0A80041",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1972691202",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAIL ROAD MEDICARE",
"identifier": "410008233",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Clare, MI
- Midmichigan Visiting Nurse Association (MidMichigan Home Care)
- Daniel Miller I
- Mission Chiropractic Family Center, P.C.
- Mitten Heart Home Care LLC
- Kara Mondeau, PA
- Edwardo Thomas Munoz, CRNA
- Mymichigan Medical Center Clare (Emergency Room Physicians of Clare and Gladwin)
- Mymichigan Medical Center Clare
- Mymichigan Medical Center Clare (MyMichigan Urgent Care Clare)
- Mymichigan Medical Center Clare (MidMichigan Urgent Care - Clare)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.