Provider Demographics
NPI:1730263013
Name:MOFFATT, TRAVIS (OD)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:MOFFATT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18423 FM 1488 RD STE D
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-8512
Mailing Address - Country:US
Mailing Address - Phone:346-386-0100
Mailing Address - Fax:
Practice Address - Street 1:18423 FM 1488 RD STE D
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-8512
Practice Address - Country:US
Practice Address - Phone:346-386-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6090TG152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0044FAOtherBCBS
TX00280PMedicare ID - Type Unspecified
TXU86181Medicare UPIN