Provider Demographics
NPI:1609937390
Name:MURRAY, NANCY L (OD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:MURRAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 319
Mailing Address - Street 2:99 STATE STREET
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412
Mailing Address - Country:US
Mailing Address - Phone:207-989-7698
Mailing Address - Fax:207-989-4055
Practice Address - Street 1:99 STATE STREET
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412
Practice Address - Country:US
Practice Address - Phone:207-989-7698
Practice Address - Fax:207-989-4055
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT670152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1609937390OtherRAILROAD MEDICARE
ME1609937390OtherRAILROAD MEDICARE
MET31687Medicare UPIN