Provider Demographics
NPI:1316114028
Name:MCELMURRAY, MICHAEL BOYCE JR (LDO)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BOYCE
Last Name:MCELMURRAY
Suffix:JR
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 RUSSELL PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5539
Mailing Address - Country:US
Mailing Address - Phone:478-328-0900
Mailing Address - Fax:478-328-2911
Practice Address - Street 1:1112 RUSSELL PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5539
Practice Address - Country:US
Practice Address - Phone:478-328-0900
Practice Address - Fax:478-328-2911
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1654156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician