MEDICARE: DR. KRISTIN S. MCMURRY O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	T03253	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00403028	OTHER	MO	RR MEDICARE
9	RR 410048088	OTHER	IL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	114348	OTHER		EYEMED
2	U75446	OTHER		MERCY HEALTH PLANS
3	20303	OTHER	MO	HEALTHCARE USA
4	22917	OTHER		OPTICARE MED.COMPLETE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	5217-004	OTHER		DAVIS VISION
8	682681	OTHER		HEALTHLINK
10	UNKNOWN	OTHER		GROUP HEALTH PLAN
11	126614	OTHER		BLUE CROSS BLUE SHIELD MO
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	126614	OTHER		BLUE CHOICE
14	22-00028	OTHER		UNITED HEALTHCARE

General Provider Information

NPI Number	:	1003885278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTIN S. MCMURRY O.D.

Provider Business Mailing Address
First Line	:	211 E BROADWAY
Second Line	:
City	:	ALTON
State	:	IL
Zip	:	62002-6220
Country	:	US
Telephone Number	:	314-842-5858
Fax Number	:	800-432-6004

Provider Business Practice Location Address
First Line	:	12406 TESSON FERRY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2702
Country	:	US
Telephone Number	:	314-842-5858
Fax Number	:	800-432-6004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	05/02/2008

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