DR. JACK MOORE OD
NPI 1891063236
Optometrist in Olympia, WA
About Dr. Jack Moore Od NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. JACK MOORE OD (NPI 1891063236) is an individual optometrist in Olympia, Washington, licensed in Washington (OD60240767) and active in the NPI registry since December 2011. He is enrolled in Medicare PECOS and is a graduate of Illinois College Of Optometry At Chicago (2011).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Dr. Jack Moore Od is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Jack Moore reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Saint Paul, MN 55113
- Reassigned Medicare billing, Minnesota enrollment
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 98506 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jack Moore's NPI number?
The NPI number for Jack Moore is 1891063236. It was assigned to this individual provider in the NPPES registry on December 13, 2011.
Where is Jack Moore located?
Jack Moore practices at 3700 Martin Way E #101, Olympia, WA 98506. The listed phone number is (360) 456-2020.
What is Jack Moore's specialty?
The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.
Is Jack Moore enrolled in Medicare?
Yes. Jack Moore is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Jack Moore's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jack Moore reassigns Medicare benefits to Moore Family Eyecare PLLC (Saint Paul, MN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jack Moore's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Jack Moore accept?
Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Louisiana, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 1 other insurer list Jack Moore as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Jack Moore was last updated on December 13, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dr. Jack Moore, OD · NPI 1891063236
Optometrist provider in Olympia, Washington. Individual provider, active in the CMS NPPES registry since December 13, 2011.
## Identity
- **NPI:** 1891063236 (Entity type: Individual)
- **Enumerated:** December 13, 2011
- **Primary specialty:** Optometrist · taxonomy 152W00000X
- **State license:** OD60240767 (Washington)
- **Sole proprietor:** No
## Practice location
- **Address:** 3700 MARTIN WAY E, #101, Olympia, WA 98506-5052
- **Phone:** (360) 456-2020 · **Fax:** (360) 438-2577
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health
- **Bills Medicare through:** Moore Family Eyecare PLLC (NPI 1134940505, Saint Paul, MN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Illinois College Of Optometry At Chicago, class of 2011
## Record status
- **NPPES last updated:** December 13, 2011
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Source: [NPI Profile](https://npiprofile.com/npi/1891063236) · Data from the CMS NPPES public registry.