Provider Demographics
NPI:1437231883
Name:MURRAY, ROBERT FULTON III (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FULTON
Last Name:MURRAY
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:449 FOREST AVE
Mailing Address - Street 2:STE 8
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2008
Mailing Address - Country:US
Mailing Address - Phone:207-773-3232
Mailing Address - Fax:207-773-3240
Practice Address - Street 1:449 FOREST AVE
Practice Address - Street 2:STE 8
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2008
Practice Address - Country:US
Practice Address - Phone:207-773-3232
Practice Address - Fax:207-773-3240
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT580152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MET31717Medicare UPIN