Provider Demographics
NPI:1821399783
Name:MURRAY VISION CENTER LLC
Entity Type:Organization
Organization Name:MURRAY VISION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:JACO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-753-2842
Mailing Address - Street 1:106 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2015
Mailing Address - Country:US
Mailing Address - Phone:270-753-2842
Mailing Address - Fax:
Practice Address - Street 1:106 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2015
Practice Address - Country:US
Practice Address - Phone:270-753-2842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1292DT152W00000X
KY1767DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1284490001Medicare NSC
KYDG4009Medicare PIN
KY6382Medicare PIN