| Moses Vision Care Llc | |
|
4500 Veterans Memorial Blvd Metairie LA 70006-5330 | |
| (504) 454-3791 | |
| (504) 456-3058 |
| Full Name | Moses Vision Care Llc |
|---|---|
| Speciality | Optometrist |
| Location | 4500 Veterans Memorial Blvd, Metairie, Louisiana |
| Authorized Official Name and Position | Broderick Moses (OPTOMETRIST) |
| Authorized Official Contact | 8328592394 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Moses Vision Care Llc 4500 Veterans Memorial Blvd Metairie LA 70006-5330 Ph: (504) 454-3791 | Moses Vision Care Llc 4500 Veterans Memorial Blvd Metairie LA 70006-5330 Ph: (504) 454-3791 |
| NPI Number | 1417146994 |
|---|---|
| Provider Enumeration Date | 10/19/2007 |
| Last Update Date | 02/19/2019 |
| Medicare PECOS PAC ID | 0345338547 |
|---|---|
| Medicare Enrollment ID | O20071126000242 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417146994 | NPI | - | NPPES |
| 1417146994 | Other | TX | BLUE CROSS BLUE SHIELD OF TEXAS |
| 1627348 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 1383-519T (Louisiana) | Secondary |
| 261Q00000X | Clinic/center | 6684TG (Texas) | Secondary |
| 152W00000X | Optometrist | 6684TG (Texas) | Primary |
| Provider Name | Broderick Moses |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1245342898 PECOS PAC ID: 8820036643 Enrollment ID: I20050421001354 |
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