Provider Demographics
NPI:1902972177
Name:MOON, DEBORAH ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANN
Last Name:MOON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4012 PRESTON RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7368
Mailing Address - Country:US
Mailing Address - Phone:972-985-3638
Mailing Address - Fax:972-867-7062
Practice Address - Street 1:4012 PRESTON RD
Practice Address - Street 2:SUITE 500
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7368
Practice Address - Country:US
Practice Address - Phone:972-985-3638
Practice Address - Fax:972-867-7062
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5262TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1043400062OtherGROUP NPI
TX1043400062OtherGROUP NPI
TX8D3613Medicare ID - Type Unspecified