Moore, Benjamin Alan

Moore, Benjamin Alan is an sole proprietor health care provider with primary practice located at 401 W Main St Suite A, John Day OR 97845-1075. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Moore, Benjamin Alan can be contacted via phone (541) 575-1819.

Contact Information

Primary practice address
401 W Main St Suite A John Day OR 97845-1075
Fax: (541) 575-0965
Website:

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 3268ATI Oregon

Profile Details

NPI number 1548459498
LBN Legal business name Moore, Benjamin Alan
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 16th, 2007
Last updated Jan 26th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548459498 NPPES
Oregon MEDICAID 023687

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