Provider Demographics
NPI:1598293615
Name:ZUCKERMAN, MORIAH BETH (OD)
Entity type:Individual
Prefix:
First Name:MORIAH
Middle Name:BETH
Last Name:ZUCKERMAN
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 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:100 PALMETTO HEALTH PKWY STE 350
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1756
Practice Address - Country:US
Practice Address - Phone:803-907-2020
Practice Address - Fax:803-907-7720
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003262152W00000X
SC2268152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist