Provider Demographics
NPI:1639265630
Name:MURPHY, PATRICIA A (OD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:MURPHY
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 1:416 MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-1764
Mailing Address - Country:US
Mailing Address - Phone:814-723-2283
Mailing Address - Fax:814-723-4984
Practice Address - Street 1:416 MARKET STREET
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-1764
Practice Address - Country:US
Practice Address - Phone:814-723-2283
Practice Address - Fax:814-723-4984
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT30301Medicare UPIN
PA0848910001Medicare NSC
PA418928Medicare PIN