Provider Demographics
NPI:1528103785
Name:MURCH, LAWRENCE C (OD OPTOMETRIST)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:C
Last Name:MURCH
Suffix:
Gender:M
Credentials:OD OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:17 LEWISTON ST
Mailing Address - City:MECHANIC FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04256-0125
Mailing Address - Country:US
Mailing Address - Phone:207-345-9863
Mailing Address - Fax:
Practice Address - Street 1:17 LEWISTON ST
Practice Address - Street 2:
Practice Address - City:MECHANIC FALLS
Practice Address - State:ME
Practice Address - Zip Code:04256-0125
Practice Address - Country:US
Practice Address - Phone:207-345-9863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME495152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1047230001OtherDMERC REGION A
ME116700000Medicaid
NONHMO5591255OtherAETNA
T79560OtherHARVARD PILGRIM
014094OtherANTHEM
HMO1041880OtherAETNA
620123801OtherCIGNA
HMO1041880OtherAETNA
ME1047230001Medicare NSC
NONHMO5591255OtherAETNA