Basic Information
Provider Information | |||||||||
NPI: | 1942854542 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MURPHY | ||||||||
FirstName: | ANNE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LDO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 11605 N LAMAR BLVD | ||||||||
Address2: |   | ||||||||
City: | AUSTIN | ||||||||
State: | TX | ||||||||
PostalCode: | 787532658 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7372226996 | ||||||||
FaxNumber: | 5125228836 | ||||||||
Practice Location | |||||||||
Address1: | 983 CENTRAL PARK AVE | ||||||||
Address2: |   | ||||||||
City: | SCARSDALE | ||||||||
State: | NY | ||||||||
PostalCode: | 105833211 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9148742041 | ||||||||
FaxNumber: | 9144722182 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/31/2019 | ||||||||
LastUpdateDate: | 07/31/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | 006730 | NY | Y |   | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.