Healthcare Provider Details

I. General information

NPI: 1942334057
Provider Name (Legal Business Name): MULLIS EYE INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 JENKS AVE
PANAMA CITY FL
32405-4644
US

IV. Provider business mailing address

1600 JENKS AVENUE
PANAMA CITY FL
32405
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-6666
  • Fax: 850-763-6665
Mailing address:
  • Phone: 850-763-6666
  • Fax: 850-763-6665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DARREN PAYNE
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 850-763-6666