Provider Demographics
NPI: | 1346647922 |
---|---|
Name: | MURRAY, BERNARD II |
Entity type: | Individual |
Prefix: | |
First Name: | BERNARD |
Middle Name: | |
Last Name: | MURRAY |
Suffix: | II |
Gender: | M |
Credentials: | |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 3841 GREEN HILLS VILLAGE DR STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | NASHVILLE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37215-2691 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 10933 71ST RD STE 2C |
Practice Address - Street 2: | |
Practice Address - City: | FOREST HILLS |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11375-4800 |
Practice Address - Country: | US |
Practice Address - Phone: | 929-281-2774 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2014-11-26 |
Last Update Date: | 2024-07-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
104100000X, 390200000X | ||
TN | 3744 | 207W00000X |
NY | 009852 | 152W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |