Provider Demographics
NPI:1679680946
Name:MURRILL, CYNTHIA A (OD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:MURRILL
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:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2915 S ALDER ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-4803
Practice Address - Country:US
Practice Address - Phone:253-473-0275
Practice Address - Fax:253-473-0706
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001387152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA410017359OtherRAIL ROAD MEDICARE
WA410043368OtherRAIL ROAD MEDICARE
WA410017367OtherRAIL ROAD MEDICARE
WAG000917201Medicare PIN
WAG000686621Medicare PIN
WA410017359OtherRAIL ROAD MEDICARE
WAGAB09177Medicare PIN
T01742Medicare UPIN
WAG0001056805Medicare PIN
WAG000165104Medicare PIN