Provider Demographics
NPI:1215001383
Name:MURRAY, RICHARD C (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:MURRAY
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 1:10454 OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1433
Mailing Address - Country:US
Mailing Address - Phone:208-672-1370
Mailing Address - Fax:208-672-1404
Practice Address - Street 1:10454 OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1433
Practice Address - Country:US
Practice Address - Phone:208-672-1370
Practice Address - Fax:208-672-1404
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP782152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID004321300Medicaid
U31021Medicare UPIN
ID004321300Medicaid
ID15945021Medicare PIN