DR. MARK EDWARD MOORE (NPI# 1730289935) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730289935 |
| Entity Type | Individual |
| Full Name | DR. MARK EDWARD MOORE |
| Credential | O.D. |
| Practice Address |
3333 S Crater Rd Ste 2d Petersburg VA 23805-9276 |
| Practice Telephone | 8047323937 |
| Practice Fax Number | 8047336005 |
| Mailing Telephone | 8047323937 |
| Mailing Fax Number | 8047336005 |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2017-06-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 0618001005 | VA | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | BLUE CROSS | 080634 | 01 |
| VA | 009235221 | 05 |
| 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 |
| 1346338530 | Mark Douglas Moore | Optometrist | 2020 N Tyler Rd Ste 124, Wichita, KS 67212-4916 | 2006-10-11 |
| 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 |
3333 S CRATER RD STE 2D |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23805-9276 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497935829 | Crater Vision Inc | Optometrist | 3333 S Crater Rd Ste 2d, Petersburg, VA 23805-9276 | 2007-11-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134690647 | Miles Viant | Occupational Therapist | 287 E Blvd, Petersburg, VA 23805 | 2018-12-10 |
| 1245756964 | Dexter Shabazz Lett | Registered Nurse | 10543 S. Crater Rd, S. Prince George, VA 23805 | 2017-08-15 |
| 1891145876 | Taylor Enhanced Living | Counselor | 105 Holly Hill Dive, Suite A, Petersburg, VA 23805 | 2016-06-21 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1932582541 | Valeria Edda Madrid Malo Bohorquez | Internal Medicine | 50 Medical Park Blvd Ste C, Petersburg, VA 23805 | 2015-06-30 |
| 1548642788 | Justin Andrew Phillingane | Podiatrist | 3335 S Crater Rd Ste 500, Petersburg, VA 23805 | 2015-06-24 |
| 1225417082 | Paladin Dermatology LLC | Nurse Practitioner | 44 A& B Medical Park Blvd, Petersburg, VA 23805 | 2015-05-27 |
| 1245652544 | Family Services Inc. | Health Maintenance Organization | 1045 Gustavo Lane, Petersburg, VA 23805 | 2014-01-06 |
| 1619268075 | Charlene Belangia | Massage Therapist | 3323 S. Crater Rd, Suite B, Petersburg, VA 23805 | 2011-04-20 |
| 1760709638 | Caresouth Hha Holdings of Virginia, LLC | Home Health | 34 Medical Park Boulevard, Suite G-h, Petersburg, VA 23805 | 2010-04-30 |
| Find all providers in zip 23805 | ||||
| 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 |
|---|---|---|---|---|
| 1245303213 | Cheryl L Bennett | Optometrist | 28 Virginia Ave, Petersburg, WV 26847 | 2006-11-16 |
| 1275592909 | James N. Matson | Optometrist | Petersburg Medical Center, Petersburg, AK 99833 | 2006-03-21 |
| 1902808710 | Patricia Louise Testamark | Optometrist | 44 Medical Park Blvd, Ste H, Petersburg, VA 23805-9349 | 2005-08-11 |
| 1053319293 | Ajit D Tiwari | Optometrist | 300 S Sycamore St, Petersburg, VA 23803-5041 | 2005-07-12 |
| 1720525322 | Cheryl L Bennett Od Pllc | Optometrist | 28 Virginia Ave, Petersburg, WV 26847-1740 | 2017-01-21 |
| 1528322195 | Crs Optical PC | Optometrist | 715 S 9th St, Petersburg, IN 47567-1820 | 2012-06-28 |
| 1033470539 | Legacy Eye Care | Optometrist | 3500 S Crater Rd, Petersburg, VA 23805-9204 | 2012-06-01 |
| 1447511001 | Robert Joaquin Foster | Optometrist | 3500 S Crater Rd, Petersburg, VA 23805-9204 | 2012-05-30 |
| 1821327040 | Dr. Thomas H. Robertson Ltd. | Optometrist | 1980 S Sycamore St, Petersburg, VA 23805-2729 | 2009-12-17 |
| 1427222603 | Ajit D. Tiwari, O.d. | Optometrist | 300 S Sycamore St, Petersburg, VA 23803-5041 | 2008-04-17 |
| Find all providers in PETERSBURG | ||||
| City | PETERSBURG |
| Zip Code | 23805 |
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| 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.