Provider Demographics
NPI:1215151527
Name:MOSER EYES, INC
Entity type:Organization
Organization Name:MOSER EYES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-746-4240
Mailing Address - Street 1:2800 S COLUMBIA RD
Mailing Address - Street 2:COLUMBIA MALL, BOX 29
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6076
Mailing Address - Country:US
Mailing Address - Phone:701-746-4240
Mailing Address - Fax:701-775-5112
Practice Address - Street 1:2800 S COLUMBIA RD
Practice Address - Street 2:COLUMBIA MALL, BOX 29
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6076
Practice Address - Country:US
Practice Address - Phone:701-746-4240
Practice Address - Fax:701-775-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND141143156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8B934STOtherBLUE CROSS BLUE SHIELD
ND022965OtherBLUE CROSS BLUE SHIELD
ND18351OtherSPECTERA
NDMOS 892718OtherVISION SERVICES INC
NDND 1143OtherEYEMED
ND24377OtherAVESIS