Provider Demographics
NPI:1003885278
Name:MCMURRY, KRISTIN S (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:S
Last Name:MCMURRY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:211 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6220
Mailing Address - Country:US
Mailing Address - Phone:314-842-5858
Mailing Address - Fax:800-432-6004
Practice Address - Street 1:12406 TESSON FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2702
Practice Address - Country:US
Practice Address - Phone:314-842-5858
Practice Address - Fax:800-432-6004
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03253152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
114348OtherEYEMED
U75446OtherMERCY HEALTH PLANS
MO20303OtherHEALTHCARE USA
22917OtherOPTICARE MED.COMPLETE
MOP00403028OtherRR MEDICARE
MO314844416Medicaid
5217-004OtherDAVIS VISION
682681OtherHEALTHLINK
ILRR 410048088OtherRR MEDICARE
UNKNOWNOtherGROUP HEALTH PLAN
126614OtherBLUE CROSS BLUE SHIELD MO
MO314844408Medicaid
126614OtherBLUE CHOICE
22-00028OtherUNITED HEALTHCARE
126614OtherBLUE CROSS BLUE SHIELD MO
682681OtherHEALTHLINK
5217-004OtherDAVIS VISION