| Alvaro J Moreno OD PC | |
|
598 E Central Ave Petal MS 39465-2957 | |
| (601) 450-3937 | |
| (601) 909-6104 |
| Full Name | Alvaro J Moreno OD PC |
|---|---|
| Speciality | Clinic/Center |
| Location | 598 E Central Ave, Petal, Mississippi |
| Authorized Official Name and Position | Alvaro J Moreno (OWNER) |
| Authorized Official Contact | 6015491553 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alvaro J Moreno OD PC 598 E Central Ave Petal MS 39465-2957 Ph: (601) 450-3937 | Alvaro J Moreno OD PC 598 E Central Ave Petal MS 39465-2957 Ph: (601) 450-3937 |
| NPI Number | 1013085935 |
|---|---|
| Provider Enumeration Date | 11/30/2006 |
| Last Update Date | 09/08/2020 |
| Certification Date | 09/08/2020 |
| Medicare PECOS PAC ID | 4789004193 |
|---|---|
| Medicare Enrollment ID | O20201022002985 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013085935 | NPI | - | NPPES |
| 08637209 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Primary |
| 152W00000X | Optometrist | 610 (Mississippi) | Secondary |
| Provider Name | Alvaro Moreno |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1548347834 PECOS PAC ID: 2062628035 Enrollment ID: I20101206000744 |
| Provider Name | Alvaro Paul Moreno |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1518577337 PECOS PAC ID: 7719397942 Enrollment ID: I20201029001258 |
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