Provider Demographics
NPI:1528440328
Name:MOORE, CAITLYN (OD)
Entity type:Individual
Prefix:DR
First Name:CAITLYN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11860 CRANSTON DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4886
Mailing Address - Country:US
Mailing Address - Phone:901-867-5540
Mailing Address - Fax:
Practice Address - Street 1:140 PEACHTREE PLZ
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38012-2500
Practice Address - Country:US
Practice Address - Phone:731-772-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3251152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist