Provider Demographics
NPI:1326105859
Name:TANNER OPTICAL, INC.
Entity Type:Organization
Organization Name:TANNER OPTICAL, INC.
Other - Org Name:MURPHY EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:912-383-7212
Mailing Address - Street 1:305 SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-2333
Mailing Address - Country:US
Mailing Address - Phone:912-383-7212
Mailing Address - Fax:912-384-4924
Practice Address - Street 1:305 SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2333
Practice Address - Country:US
Practice Address - Phone:912-383-7212
Practice Address - Fax:912-384-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001767152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA410048167OtherRAILROAD
GAOPT001767OtherGA LIC
GA00861506BMedicaid
GA00861506BMedicaid
GA410048167OtherRAILROAD
GA41ZCFCZMedicare PIN
GA00861506BMedicaid
GAMM0455546OtherDEA