Provider Demographics
NPI:1194032169
Name:DR MURRAY TAUBMAN AN OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:DR MURRAY TAUBMAN AN OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MURRAY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAUBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-894-3353
Mailing Address - Street 1:12568 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2006
Mailing Address - Country:US
Mailing Address - Phone:714-894-3353
Mailing Address - Fax:714-373-0670
Practice Address - Street 1:12568 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-2006
Practice Address - Country:US
Practice Address - Phone:714-894-3353
Practice Address - Fax:714-373-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6125T261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00939988OtherRAILROAD MEDICARE PTAN
CASD0061250Medicaid
CA0373010001Medicare NSC
CADM072AMedicare PIN
CAT70089Medicare UPIN