Provider Demographics
NPI:1992800767
Name:MURPHY, TIMOTHY (OPTICIAN)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:MURPHY
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-1215
Mailing Address - Country:US
Mailing Address - Phone:413-283-3511
Mailing Address - Fax:413-283-5396
Practice Address - Street 1:1504 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1215
Practice Address - Country:US
Practice Address - Phone:413-283-3511
Practice Address - Fax:413-283-5396
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1334156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician