Provider Demographics
NPI:1346205077
Name:MURPHY, KEVIN ADAM (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ADAM
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 1:305 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4703740001OtherPALMETTO GBA
GA930330OtherBLUE CROSS & BLUE SHIELD
GA860349350OtherAVESIS
GAGA1767OtherEYEMED
GA00861506BMedicaid
GATO19417OtherSPECTERA
GA930330OtherBLUE CROSS & BLUE SHIELD
GAGA1767OtherEYEMED