Provider Demographics
NPI:1821002650
Name:MURRAY, BRIAN ROY (OD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ROY
Last Name:MURRAY
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 1:621 N RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3127
Mailing Address - Country:US
Mailing Address - Phone:931-647-5237
Mailing Address - Fax:931-647-5254
Practice Address - Street 1:621 N RIVERSIDE DR
Practice Address - Street 2:SITES VISION CLINIC
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040
Practice Address - Country:US
Practice Address - Phone:931-647-5237
Practice Address - Fax:931-647-5254
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1759152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3940864Medicaid
4113057OtherBCBS
KY1881711786OtherGROUP NPI
4113057OtherBCBS
KY1881711786OtherGROUP NPI
U63713Medicare UPIN