Provider Demographics
NPI:1871684035
Name:MURFIN, JOHNNIE GENE
Entity Type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:GENE
Last Name:MURFIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:G
Other - Last Name:MURFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2809 KOLBY CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704
Mailing Address - Country:US
Mailing Address - Phone:309-451-1500
Mailing Address - Fax:309-451-1008
Practice Address - Street 1:300 N GREENBRIAR DR
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761
Practice Address - Country:US
Practice Address - Phone:309-451-1500
Practice Address - Fax:309-451-1008
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005721315OtherBCBS OF IL
0005721315OtherBCBS OF IL
978110Medicare ID - Type Unspecified