Provider Demographics
NPI:1598742298
Name:MURPHY, THOMAS H (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:MURPHY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1689 ARDEN FAIR MALL,
Mailing Address - Street 2:SUITE 1091
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815
Mailing Address - Country:US
Mailing Address - Phone:916-929-5909
Mailing Address - Fax:916-929-8202
Practice Address - Street 1:1689 ARDEN FAIR MALL,
Practice Address - Street 2:SUITE 1091
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815
Practice Address - Country:US
Practice Address - Phone:916-929-5909
Practice Address - Fax:916-929-8202
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6518T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD006418Medicaid
CASD006518Medicare ID - Type UnspecifiedMEDICARE NUMBER
CASD006418Medicaid