Provider Demographics
NPI:1598575318
Name:MOORE, ANN (LDO)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:BELK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2377 DAVE LYLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-7939
Mailing Address - Country:US
Mailing Address - Phone:803-366-9404
Mailing Address - Fax:
Practice Address - Street 1:2377 DAVE LYLE BLVD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-7939
Practice Address - Country:US
Practice Address - Phone:803-366-9404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC350156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician