=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659507473
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEVEN B. MCMURRY OD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2009
-----------------------------------------------------
Last Update Date | 06/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3062 S STATE RD
-----------------------------------------------------
City | IONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48846-9416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-527-5894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2101 BROOK TRAILS CT SE
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49508-2654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STEVEN B. MCMURRY
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 616-248-4784
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4901003274
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------