Healthcare Provider Details

I. General information

NPI: 1306022850
Provider Name (Legal Business Name): CRAIG P MURTHA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2368 CHERRY RD
ROCK HILL SC
29732-2165
US

IV. Provider business mailing address

2368 CHERRY RD
ROCK HILL SC
29732-2165
US

V. Phone/Fax

Practice location:
  • Phone: 803-366-6111
  • Fax: 803-366-6544
Mailing address:
  • Phone: 803-366-6111
  • Fax: 803-366-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number781
License Number StateSC

VIII. Authorized Official

Name: DR. CRAIG P MURTHA
Title or Position: OWNER
Credential: O.D.
Phone: 803-366-6111