Moore, Evelyn Marie

Moore, Evelyn Marie is an individual health care provider with primary practice located at 2032 N Prospect Ave , Champaign IL 61822-1240. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Moore, Evelyn Marie can be contacted via phone (217) 954-1085.

Contact Information

Primary practice address
2032 N Prospect Ave Champaign IL 61822-1240
Phone: (217) 954-1085
Fax: (217) 607-5457
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 046.006881 Illinois

Profile Details

NPI number 1497826655
LBN Legal business name Moore, Evelyn Marie
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 10th, 2006
Last updated Dec 30th, 2016 - about 10 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 1497826655 NPPES
Illinois Other 0001084006 BLUE CROSS BLUE SHIELD

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