Provider Demographics
NPI:1437199544
Name:MURRAY, SHAWN PAGE (OD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:PAGE
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 1:190 S 500 W
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8729
Mailing Address - Country:US
Mailing Address - Phone:801-295-9200
Mailing Address - Fax:801-292-9390
Practice Address - Street 1:190 S 500 W
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8729
Practice Address - Country:US
Practice Address - Phone:801-295-9200
Practice Address - Fax:801-292-9390
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4769112-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT410985054229Medicaid
UT410985054229Medicaid