Provider Demographics
NPI:1518091545
Name:MURTHA, CHRISTOPHER T (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:T
Last Name:MURTHA
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 NORTH AVE
Mailing Address - Street 2:#34
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-2757
Mailing Address - Country:US
Mailing Address - Phone:802-658-6700
Mailing Address - Fax:
Practice Address - Street 1:1127 NORTH AVE
Practice Address - Street 2:#34
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-2757
Practice Address - Country:US
Practice Address - Phone:802-658-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0280000210156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006612Medicaid
VT0289780001Medicare ID - Type Unspecified