Provider Demographics
NPI:1013226471
Name:MURRAY VISION SOURCE INC
Entity Type:Organization
Organization Name:MURRAY VISION SOURCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:O D
Authorized Official - Phone:334-699-5999
Mailing Address - Street 1:550 JOHN D ODOM RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-9461
Mailing Address - Country:US
Mailing Address - Phone:334-699-5999
Mailing Address - Fax:334-479-0631
Practice Address - Street 1:550 JOHN D ODOM RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-9461
Practice Address - Country:US
Practice Address - Phone:334-699-5999
Practice Address - Fax:334-479-0631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS900TA450152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6475220001Medicare NSC