Provider Demographics
NPI:1033294905
Name:TAUBMAN, MURRAY (OD)
Entity type:Individual
Prefix:DR
First Name:MURRAY
Middle Name:
Last Name:TAUBMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12568 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2006
Mailing Address - Country:US
Mailing Address - Phone:714-894-3353
Mailing Address - Fax:714-373-0670
Practice Address - Street 1:12568 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-2006
Practice Address - Country:US
Practice Address - Phone:714-894-3353
Practice Address - Fax:714-373-0670
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6125T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0061250Medicaid
CAT70089Medicare UPIN
CADM073ZMedicare PIN