Healthcare Provider Details

I. General information

NPI: 1619060522
Provider Name (Legal Business Name): GARY WILLIAM MURRELL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E 10TH ST SUITE C
ANNISTON AL
36207-4787
US

IV. Provider business mailing address

425 E 10TH ST SUITE C
ANNISTON AL
36207-4787
US

V. Phone/Fax

Practice location:
  • Phone: 256-236-7516
  • Fax: 256-237-6730
Mailing address:
  • Phone: 256-236-7516
  • Fax: 256-237-6730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS514TA101
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: