Healthcare Provider Details

I. General information

NPI: 1356679393
Provider Name (Legal Business Name): MURLEY OPTOMETRIC INC., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 COMMERCE DR
LAFAYETTE IN
47905-3800
US

IV. Provider business mailing address

21 DRAWBRIDGE CT
LAFAYETTE IN
47905-7812
US

V. Phone/Fax

Practice location:
  • Phone: 765-446-0058
  • Fax: 765-446-1331
Mailing address:
  • Phone: 765-448-1130
  • Fax: 765-446-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002636AB
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number18002636AB
License Number StateIN

VIII. Authorized Official

Name: DR. ERIN MURLEY
Title or Position: PRESIDENT
Credential: O.D.
Phone: 765-448-1130