MEDICARE: DR. BERNARD MULLIN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	27OA00457800	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410034332	OTHER		RAILROAD MEDICARE
5	410015466	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0287749	OTHER	NJ	CIGNA
4	4573646	OTHER	NJ	AETNA PROVIDER ID

General Provider Information

NPI Number	:	1487650354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNARD MULLIN O.D.

Provider Business Mailing Address
First Line	:	438 COUNTY ROAD 513
Second Line	:
City	:	CALIFON
State	:	NJ
Zip	:	07830-4187
Country	:	US
Telephone Number	:	908-832-9211
Fax Number	:	908-832-5806

Provider Business Practice Location Address
First Line	:	438 COUNTY ROAD 513
Second Line	:
City	:	CALIFON
State	:	NJ
Zip	:	07830-4187
Country	:	US
Telephone Number	:	908-832-9211
Fax Number	:	908-832-5806

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	04/13/2009

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Directions to “ DR. BERNARD MULLIN O.D.” Practice Location

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