Basic Information
| Provider Information | |||||||||
| NPI: | 1174616924 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURRAY | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 S HIGH ST | ||||||||
| Address2: | |||||||||
| City: | CANAL WINCHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431101251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148377725 | ||||||||
| FaxNumber: | 6148377301 | ||||||||
| Practice Location | |||||||||
| Address1: | 5555 HILLIARD ROME OFFICE PARK | ||||||||
| Address2: | |||||||||
| City: | HILLIARD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430267287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147771111 | ||||||||
| FaxNumber: | 6147777920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 10/11/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4577 T1320 | OH | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 0030933 | 05 | OH | MEDICAID |