Provider Demographics
NPI:1467423566
Name:MURPHY, GEORGE MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:MURPHY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:G.
Other - Middle Name:MICHAEL
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:4933 BENCHMARK CENTRE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-8927
Mailing Address - Country:US
Mailing Address - Phone:618-628-3939
Mailing Address - Fax:618-628-3959
Practice Address - Street 1:4933 BENCHMARK CENTRE DR
Practice Address - Street 2:SUITE D
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-8927
Practice Address - Country:US
Practice Address - Phone:618-628-3939
Practice Address - Fax:618-628-3959
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-007817152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046-007817Medicaid
UO9738Medicare UPIN
IL212878Medicare PIN