Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1124194824 |
---|---|
Provider Name | Mr. Richard Royal Murdock JR. |
First Address | Lansing, MI 48933-1701 |
Second Address | Lansing, MI 48933-1701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 07/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
90OC310390 | BCBS (01) | MI |