NPI 1063080554

Jacob Bradley Moore

Practitioner Optometrist Columbia, MO

Practice location

Address: 500 N Keene St Suite 103, Columbia, MO 65201-8104
Phone: (573) 874-2030
Fax: (573) 449-0253

Registered specialties

Optometrist Primary

Eye and Vision Services Providers Taxonomy 152W00000X Licence 2021020987 (MO)

Other Optometrist providers in Missouri →

Registry record

NPI: 1063080554
Entity type: Individual
Sex (as registered): Male
NPI issued: 11 Jun 2021
Record last updated: 11 Jun 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.