Provider Demographics
NPI:1992770952
Name:MOYER, JASON G (OD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:G
Last Name:MOYER
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 E BOOKER DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-9405
Mailing Address - Country:US
Mailing Address - Phone:919-938-6101
Mailing Address - Fax:919-938-6103
Practice Address - Street 1:1680 E BOOKER DAIRY RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-9405
Practice Address - Country:US
Practice Address - Phone:919-938-6101
Practice Address - Fax:919-938-6103
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE130001291152W00000X
NC2852152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE2363945000OtherAMERIHEALTH
DE1000035048Medicaid
11320521OtherCAQH
DE5101110PTOtherBCBS OF DELAWARE
DE1000035048Medicaid