Provider Demographics
NPI:1518181486
Name:MURPHY WATSON BURR EYE CENTER INC
Entity Type:Organization
Organization Name:MURPHY WATSON BURR EYE CENTER INC
Other - Org Name:MURPHY WATSON BURR OPTICAL SHOP
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-233-2020
Mailing Address - Street 1:5202 FARAON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3840
Mailing Address - Country:US
Mailing Address - Phone:816-233-2020
Mailing Address - Fax:816-279-4662
Practice Address - Street 1:5202 FARAON ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3809
Practice Address - Country:US
Practice Address - Phone:816-233-2020
Practice Address - Fax:816-279-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD R7N30332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO328553003Medicaid
MOG33390Medicare UPIN
MOD84052Medicare UPIN
MOU97970Medicare UPIN
MO328553003Medicaid
MOU87090Medicare UPIN
MOC51577Medicare UPIN
MOU78838Medicare UPIN
MO0783060001Medicare ID - Type UnspecifiedNORIDIAN ADMINISTRATORS