Provider Demographics
NPI:1073513057
Name:BAIZE-MOORE, MARY JO (OD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JO
Last Name:BAIZE-MOORE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-9815
Mailing Address - Country:US
Mailing Address - Phone:270-759-1429
Mailing Address - Fax:270-759-1493
Practice Address - Street 1:1806 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-9815
Practice Address - Country:US
Practice Address - Phone:270-759-1429
Practice Address - Fax:270-759-1493
Is Sole Proprietor?:No
Enumeration Date:2005-07-30
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2467152W00000X
KY2300DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20253BMedicare NSC
FLU12672Medicare UPIN