Provider Demographics
NPI:1386668705
Name:MURRAY, PAULA PUTMAN (OD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:PUTMAN
Last Name:MURRAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 N RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3127
Mailing Address - Country:US
Mailing Address - Phone:270-265-9036
Mailing Address - Fax:270-265-0013
Practice Address - Street 1:621 N RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3147
Practice Address - Country:US
Practice Address - Phone:931-647-5237
Practice Address - Fax:270-265-0013
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1758152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77013621Medicaid
1881711786OtherGROUP NPI
KY77013621Medicaid
KYU65620Medicare UPIN