Provider Demographics
NPI:1659472637
Name:MURTHA, CRAIG P (OD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:P
Last Name:MURTHA
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 1:2368 CHERRY RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2165
Mailing Address - Country:US
Mailing Address - Phone:803-366-6111
Mailing Address - Fax:803-366-6544
Practice Address - Street 1:2368 CHERRY RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2165
Practice Address - Country:US
Practice Address - Phone:803-366-6111
Practice Address - Fax:803-366-6544
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC781152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0617420001Medicare NSC
SCT235610281Medicare UPIN