Provider Demographics
NPI:1417938010
Name:MOSES, ROBERT WILLIAM (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:MOSES
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 1:70 E 68TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-3506
Mailing Address - Country:US
Mailing Address - Phone:219-736-2020
Mailing Address - Fax:219-769-3884
Practice Address - Street 1:70 E 68TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-3506
Practice Address - Country:US
Practice Address - Phone:219-736-2020
Practice Address - Fax:219-769-3884
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001579152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100362050Medicaid
IN410016959OtherRAILROAD MEDICARE
IN410040620OtherRAILROAD MEDICARE
IN580001141OtherRAILROAD MEDICARE
IN410041743OtherRAILROAD MEDICARE
IN410041743OtherRAILROAD MEDICARE
IN100362050Medicaid
INT34805Medicare UPIN
INM400032247Medicare PIN
IN496000AMedicare PIN