Provider Demographics
NPI:1780886531
Name:MOFFETT, JOHN CLARK (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLARK
Last Name:MOFFETT
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:8403 FLOWER MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-7423
Mailing Address - Country:US
Mailing Address - Phone:214-553-9900
Mailing Address - Fax:214-553-9902
Practice Address - Street 1:1514 E BELT LINE RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6369
Practice Address - Country:US
Practice Address - Phone:972-242-2020
Practice Address - Fax:214-553-9902
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX02501152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX02501OtherLICENCE