Provider Demographics
NPI:1568091551
Name:MURTHY, NITYA (OD)
Entity Type:Individual
Prefix:
First Name:NITYA
Middle Name:
Last Name:MURTHY
Suffix:
Gender:F
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:PO BOX 4830
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540-4830
Mailing Address - Country:US
Mailing Address - Phone:956-631-8875
Mailing Address - Fax:956-683-1502
Practice Address - Street 1:1006 E HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3287
Practice Address - Country:US
Practice Address - Phone:956-724-7179
Practice Address - Fax:956-725-2402
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN390200000X
IN18004219A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty