MEDICARE: DR. MARY A MURPHY O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TO2797	MO

General Provider Information

NPI Number	:	1134118102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY A MURPHY O.D.

Provider Business Mailing Address
First Line	:	9051 WATSON RD STE D
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-2240
Country	:	US
Telephone Number	:	314-962-1700
Fax Number	:	314-962-3297

Provider Business Practice Location Address
First Line	:	9051 WATSON RD STE D
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-2240
Country	:	US
Telephone Number	:	314-962-1700
Fax Number	:	314-962-3297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	01/14/2019

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