=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083897706
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL MURPHY, OD VISION CARE ASSOCIATES, LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2007
-----------------------------------------------------
Last Update Date | 12/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4933 BENCHMARK CENTRE DR SUITE D
-----------------------------------------------------
City | SWANSEA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62226-8927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-628-3939
-----------------------------------------------------
Fax | 618-628-3959
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4933 BENCHMARK CENTRE DR SUITE D
-----------------------------------------------------
City | SWANSEA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62226-8927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-628-3939
-----------------------------------------------------
Fax | 618-628-3959
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GEORGE MICHAEL MURPHY
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 618-628-3939
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 046-007817
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------