Provider Demographics
NPI:1679520621
Name:MURPHY WATSON BURR EYE CENTER INC
Entity Type:Organization
Organization Name:MURPHY WATSON BURR EYE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-233-2020
Mailing Address - Street 1:5202 FARAON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3809
Mailing Address - Country:US
Mailing Address - Phone:816-233-2020
Mailing Address - Fax:816-279-4662
Practice Address - Street 1:5202 FARAON ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3809
Practice Address - Country:US
Practice Address - Phone:816-233-2020
Practice Address - Fax:816-279-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO502343510Medicaid
MO502343510Medicaid