Provider Demographics
NPI:1730553736
Name:MOONAN, JOHN LAWRENCE III (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LAWRENCE
Last Name:MOONAN
Suffix:III
Gender:M
Credentials:OD
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Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:860 SUMMIT CROSSING PL STE 110
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2217
Practice Address - Country:US
Practice Address - Phone:704-865-3937
Practice Address - Fax:704-865-8851
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-15
Last Update Date:2024-02-05
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Provider Licenses
StateLicense IDTaxonomies
NC2444152W00000X
SC1907152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist