Basic Information
| Provider Information | |||||||||
| NPI: | 1063463842 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURPHY | ||||||||
| FirstName: | HOWARD | ||||||||
| MiddleName: | EDMOND | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3801 NORTHSIDE DR | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312102418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4784751600 | ||||||||
| FaxNumber: | 4784751876 | ||||||||
| Practice Location | |||||||||
| Address1: | 3801 NORTHSIDE DR | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312102418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4784751600 | ||||||||
| FaxNumber: | 4784751876 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 11/14/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | GA1455 | GA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.