NPI 1104366053 · live from the CMS NPI Registry
Kelly Moritz, O.D.
Optometrist in Philadelphia, PA. National Provider Identifier 1104366053, active.
NPI record
| NPI | 1104366053 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | 4002 Chestnut St, Philadelphia, PA 19104 |
| Practice phone | 215-921-4871 |
| Mailing address | 37 Bonnywick Dr, Harrisburg, PA 17111 |
| Enumerated | February 26, 2017 |
| Last updated | August 13, 2018 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Optometrist | 152W00000X | I3-0001391 (DE) |
| Optometrist primary | 152W00000X | OEG003227 (PA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.