Provider Demographics
NPI:1073518759
Name:MURPHY, MICHAEL SHANE (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHANE
Last Name:MURPHY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8560 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7435
Mailing Address - Country:US
Mailing Address - Phone:716-632-6102
Mailing Address - Fax:716-204-8639
Practice Address - Street 1:8560 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7435
Practice Address - Country:US
Practice Address - Phone:716-632-6102
Practice Address - Fax:716-204-8639
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006295-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000390180003OtherBLUE CROSS/BLUE SHIELD
NY251744484OtherNORTH AMERICAN PREFERRED
NY2091959OtherUNITED HEALTH CARE
NY02506169Medicaid
NY7290362OtherINDEPENDENT HEALTH
NYNY6295OtherEYEMED
NY000390180001OtherCOMMUNITY BLUE
NY251744484OtherNOVA
NY000390180002OtherCOMMUNITY BLUE
NY115838CSOtherPREFERRED CARE
NYP00412808OtherMEDICARE RAILROAD
NY00025494903OtherUNIVERA
NY161578122OtherEMPIRE - UNITED HEALTHCAR
NY161578122OtherNOVA
NY251744484OtherEMPIRE - UNITED HEALTHCAR
NY7461797OtherAETNA
NY9382737OtherPHCS
NY115838CSOtherPREFERRED CARE
NY251744484OtherNORTH AMERICAN PREFERRED
NY000390180001OtherCOMMUNITY BLUE
NY161578122OtherEMPIRE - UNITED HEALTHCAR