Provider Demographics
NPI:1689830929
Name:MURPHY, ANDREA L (OD, FAAO)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:L
Last Name:MURPHY
Suffix:
Gender:F
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 NORTH MAIN STREET, DESK 100 (112)
Mailing Address - Street 2:DEPARTMENT OF VETERAN AFFAIRS
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05009
Mailing Address - Country:US
Mailing Address - Phone:802-295-9363
Mailing Address - Fax:802-296-5112
Practice Address - Street 1:215 NORTH MAIN STREET, DESK 100 (112)
Practice Address - Street 2:DEPARTMENT OF VETERAN AFFAIRS
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05009
Practice Address - Country:US
Practice Address - Phone:802-295-9363
Practice Address - Fax:802-296-5112
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0000351152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1861Medicaid
NH30210240Medicaid
NH30210240Medicaid
VTOVN1861Medicaid