1285627893 NPI number — DR. DENISE MURPHREE SHOW O.D.

Table of content: DR. DENISE MURPHREE SHOW O.D. (NPI 1285627893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285627893 NPI number — DR. DENISE MURPHREE SHOW O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHOW
Provider First Name:
DENISE
Provider Middle Name:
MURPHREE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLS
Provider Other First Name:
DENISE
Provider Other Middle Name:
MURPHREE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285627893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SHOW VISION, LLC
Provider Second Line Business Mailing Address:
758 MONUMENT DR.
Provider Business Mailing Address City Name:
MILLBROOK
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36054-1849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-694-9001
Provider Business Mailing Address Fax Number:
334-517-4668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SHOW VISION, LLC
Provider Second Line Business Practice Location Address:
758 MONUMENT DRIVE
Provider Business Practice Location Address City Name:
MILLBROOK
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36054-1849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-694-9001
Provider Business Practice Location Address Fax Number:
334-517-4668
Provider Enumeration Date:
08/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  S831TA373 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: S831-TA373 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 171970 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 171970MCD , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000029217 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102I417946 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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