Provider Demographics
NPI:1427668136
Name:MOORE, ALISON (OD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name: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 1:1984 GALLINA CIR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-0800
Mailing Address - Country:US
Mailing Address - Phone:901-651-8461
Mailing Address - Fax:
Practice Address - Street 1:6465 N QUAIL HOLLOW RD STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-1448
Practice Address - Country:US
Practice Address - Phone:901-683-7255
Practice Address - Fax:901-683-3523
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1042152W00000X
TN0000003601152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist