Provider Demographics
NPI:1780652925
Name:MURRAY, BRENDA S (OD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:S
Last Name:MURRAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:S
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:10675 MCSWAIN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-3168
Mailing Address - Country:US
Mailing Address - Phone:513-563-2304
Mailing Address - Fax:513-563-2356
Practice Address - Street 1:10675 MCSWAIN DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-3168
Practice Address - Country:US
Practice Address - Phone:513-563-2304
Practice Address - Fax:513-563-2356
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4672/T1447152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0218231Medicaid
OH0218231Medicaid
OHU60062Medicare UPIN