DR. MARK DOUGLAS MOORE (NPI# 1346338530) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346338530 |
| Entity Type | Individual |
| Full Name | DR. MARK DOUGLAS MOORE |
| Credential | O. D. |
| Practice Address |
2020 N Tyler Rd Ste 124 Wichita KS 67212-4916 |
| Practice Telephone | 3167290083 |
| Practice Fax Number | 3167290052 |
| Mailing Telephone | 3167290083 |
| Mailing Fax Number | 3167290052 |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2012-03-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 1367 | KS | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KS | PHS/PPK | 2531 | 01 |
| KS | BCBSKS | 049695 | 01 |
| KS | BCBSKS | 018096 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073031019 | Mark Daniel Moore | Psychologist | 100 Miner St, Crescent City, IL 60928-8092 | 2017-08-30 |
| 1114462017 | Mark Christopher Moore | Anesthesiologist Assistant | 8000 E Maplewood Ave Bldg 5, Ste. 200, Greenwood Village, CO 80111-4766 | 2016-12-30 |
| 1699981183 | Mark Wayne Moore | Dentist | 2301 12th St, Meridian, MS 39301-3934 | 2007-05-14 |
| 1588747588 | Mark W Moore | Physical Therapist | 6036 N 19th Ave Ste 303, Phoenix, AZ 85015 | 2006-10-23 |
| 1730289935 | Mark Edward Moore | Optometrist | 3333 S Crater Rd Ste 2d, Petersburg, VA 23805-9276 | 2006-09-25 |
| 1043328800 | Mark D Moore | Optometrist | 504 Peterson Ave S, Douglas, GA 31533-5254 | 2006-08-29 |
| 1104934462 | Mark Stephen Moore | Dentist | 5501 Matlock Rd, Arlington, TX 76018-1534 | 2006-08-28 |
| 1225022833 | Mark Phillip Moore | Dentist | 2048 Windward Ln, Gainesville, GA 30501-7418 | 2005-09-09 |
| 1710527130 | Mark Moore | Community Health Worker | 1114 Lane 12, Lovell, WY 82431-9555 | 2020-01-14 |
| 1467940049 | Mark Andrew Moore | Pharmacist | 1102 N Gateway Ave, Rockwood, TN 37854-4109 | 2018-04-29 |
| Street Address |
2020 N TYLER RD STE 124 |
| City | WICHITA |
| State | KS |
| Zip Code | 67212-4916 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891396974 | Kim Deann Kercher | Physical Therapist | Legacy At Grassland Estates, 10665 W 13th St N Apt 329, Wichita, KS 67212 | 2020-11-04 |
| 1700370954 | Andrea Lou Wheeler | Registered Nurse | 658 N Fairway Ave, Wichita, KS 67212 | 2018-06-20 |
| 1568981231 | Wichita Family Dental LLC | Dentist | 1445 N. Ridge Rd, Wichtia, KS 67212 | 2017-09-14 |
| 1396260121 | Keegan Hemberger | Pharmacist | 555 N. Maize Road, Wichita, KS 67212 | 2017-08-14 |
| 1154877603 | Alicia Rose Landrum | Counselor | 515 N Ridge Rd Ste 105, Wichita, KS 67212 | 2016-08-25 |
| 1306218920 | Brandee Young | Occupational Therapist | 9710 W. Jamesburg, Wichita, KS 67212 | 2015-10-22 |
| 1588072201 | Michelle Kuhn | Pharmacist | 10515 W Central, Wichita, KS 67212 | 2014-07-25 |
| 1972914083 | Linda Mueller Mueller | Marriage & Family Therapist | 4425 West Zoo Blvd, Wichita, KS 67212 | 2014-05-12 |
| 1619392305 | Jessica Smith | Counselor | 1319 W May, Wichita, KS 67212 | 2014-03-04 |
| 1245652064 | Keepsake Kottage, LLC | Custodial Care Facility | 8801 W Bekemeyer, Wichita, KS 67212 | 2014-01-14 |
| Find all providers in zip 67212 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114544392 | Diana Ho | Optometrist | 980 Oliver Street, Wichita, KS 67218 | 2020-07-03 |
| 1861040909 | Larisa Rivera | Optometrist | 949 S Glendale St, Wichita, KS 67218-3210 | 2019-09-02 |
| 1427612084 | Kansas Physicians Eyecare Group, P.C. | Optometrist | 438 S Rock Rd, Wichita, KS 67207-1150 | 2019-04-29 |
| 1396213799 | Wichita Optometry, P.a. | Optometrist | 2330 N Amidon Ave, Wichita, KS 67204-5630 | 2018-11-05 |
| 1710463500 | Macey Pruett | Optometrist | 982 N Tyler Rd Ste A, Wichita, KS 67212-3271 | 2018-07-14 |
| 1295116333 | Jedediah Reece | Optometrist | 7570 W 21st St N Ste 1002, Wichita, KS 67205-1763 | 2015-06-15 |
| 1093121097 | The Eye Gallery, LLC | Optometrist | 3084 N. Maize Rd, Wichita, KS 67205 | 2014-07-10 |
| 1427498047 | Vanlang Q Huynh | Optometrist | 7700 E Kellogg Dr Ste 703a, Wichita, KS 67207-1787 | 2013-06-27 |
| 1063790145 | Megan Nichole Baldwin | Optometrist | 2146 N Collective Ln, 110, Wichita, KS 67206-3573 | 2011-07-24 |
| 1649578402 | Lentz Enterprises, LLC | Optometrist | 670 E 47th St S, Wichita, KS 67216-1769 | 2011-03-03 |
| Find all providers in WICHITA | ||||
Please comment or provide details below to improve the information on DR. MARK DOUGLAS MOORE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.