Basic Information
| Provider Information | |||||||||
| NPI: | 1356364681 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURRAY | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 651 NW BLUE PKWY | ||||||||
| Address2: | SUITE O-105 | ||||||||
| City: | LEES SUMMIT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640865736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166075008 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 651 NW BLUE PKWY | ||||||||
| Address2: | SUITE O-105 | ||||||||
| City: | LEES SUMMIT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640865736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166075008 | ||||||||
| FaxNumber: | 8169431250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 02/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | T03071 | MO | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 18803064 | 01 | MO | BLUE CROSS BLUE SHIELD | OTHER | 316710409 | 05 | MO | MEDICAID | 18803074 | 01 | MO | BLUE CROSS BLUE SHIELD | OTHER |