Provider Demographics
NPI:1619984481
Name:MURRELL, STACEY (OD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:MURRELL
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 1:521 S ASPEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2296
Mailing Address - Country:US
Mailing Address - Phone:918-258-9999
Mailing Address - Fax:918-258-2850
Practice Address - Street 1:521 S ASPEN AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2296
Practice Address - Country:US
Practice Address - Phone:918-258-9999
Practice Address - Fax:918-258-2850
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2009-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK2345152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100762280AMedicaid
OKU86575Medicare UPIN
OK4447210001Medicare NSC