Provider Demographics
NPI:1225313372
Name:MOORE, TIMOTHY BRIAN (OD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BRIAN
Last Name:MOORE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10627 PROFESSIONAL CIR STE B
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5834
Mailing Address - Country:US
Mailing Address - Phone:775-507-7171
Mailing Address - Fax:775-507-7172
Practice Address - Street 1:10627 PROFESSIONAL CIR STE B
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5834
Practice Address - Country:US
Practice Address - Phone:775-507-7171
Practice Address - Fax:775-507-7172
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV811152W00000X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy