Provider Demographics
NPI:1457389207
Name:THOMAS H MURPHY OD INC
Entity type:Organization
Organization Name:THOMAS H MURPHY OD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BASKETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-929-5909
Mailing Address - Street 1:1151 GALLERIA BLVD, SUITE 239
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-1944
Mailing Address - Country:US
Mailing Address - Phone:916-772-3937
Mailing Address - Fax:916-772-4779
Practice Address - Street 1:1151 GALLERIA BLVD, SUITE 239
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1944
Practice Address - Country:US
Practice Address - Phone:916-772-3937
Practice Address - Fax:916-772-4779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64888ZOtherBLUE SHIELDS
CAGDS004822Medicaid
CA314522230OtherVSP, SUPERIOR
CAZZZ29619ZMedicare ID - Type UnspecifiedMEDICARE
CA4639500002Medicare NSC