Provider Demographics
NPI:1699945717
Name:FREDERICK C. MOSES, O.D., P.C.
Entity type:Organization
Organization Name:FREDERICK C. MOSES, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-932-2953
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:35555-0776
Mailing Address - Country:US
Mailing Address - Phone:205-932-2953
Mailing Address - Fax:205-932-2852
Practice Address - Street 1:3186 HIGHWAY 171 N
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555-6172
Practice Address - Country:US
Practice Address - Phone:205-932-2953
Practice Address - Fax:205-932-2852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS396-TA-116152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT69000Medicare UPIN