Provider Demographics
NPI:1619060522
Name:MURRELL, GARY WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WILLIAM
Last Name:MURRELL
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 1:425 E 10TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4787
Mailing Address - Country:US
Mailing Address - Phone:256-236-7516
Mailing Address - Fax:256-237-6730
Practice Address - Street 1:425 E 10TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4787
Practice Address - Country:US
Practice Address - Phone:256-236-7516
Practice Address - Fax:256-237-6730
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS514TA101152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000059777Medicaid
ALT69009Medicare UPIN
AL000059777Medicaid
000059777Medicare ID - Type UnspecifiedMEDICARE NUMBER