Provider Demographics
NPI:1487618674
Name:MOORE, ROBERT L (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:MOORE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:631 HELEN KELLER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-2983
Mailing Address - Country:US
Mailing Address - Phone:205-758-1966
Mailing Address - Fax:205-758-1548
Practice Address - Street 1:631 HELEN KELLER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2983
Practice Address - Country:US
Practice Address - Phone:205-758-1966
Practice Address - Fax:205-758-1548
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS758TA061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU33456Medicare UPIN
AL58434Medicare ID - Type Unspecified