Provider Demographics
NPI:1013920552
Name:MURATORI, DAVID ALAN (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:MURATORI
Suffix:
Gender:M
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 1074
Mailing Address - Street 2:471 MEMORY LANE
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-7074
Mailing Address - Country:US
Mailing Address - Phone:216-496-5216
Mailing Address - Fax:
Practice Address - Street 1:3853 BURBANK RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-7215
Practice Address - Country:US
Practice Address - Phone:330-345-0957
Practice Address - Fax:330-345-0960
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3557/T570152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT48129Medicare UPIN