Provider Demographics
NPI:1134118102
Name:MURPHY, MARY A (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:A
Last Name:MURPHY
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:9051 WATSON RD STE D
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-2240
Mailing Address - Country:US
Mailing Address - Phone:314-962-1700
Mailing Address - Fax:314-962-3297
Practice Address - Street 1:9051 WATSON RD STE D
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-2240
Practice Address - Country:US
Practice Address - Phone:314-962-1700
Practice Address - Fax:314-962-3297
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOTO2797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T87558Medicare UPIN