Healthcare Provider Details

I. General information

NPI: 1316130073
Provider Name (Legal Business Name): MULLINS VISION ASSOCIATES,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 E 10TH ST
COOKEVILLE TN
38501-1886
US

IV. Provider business mailing address

585 E 10TH ST
COOKEVILLE TN
38501-1886
US

V. Phone/Fax

Practice location:
  • Phone: 931-526-6711
  • Fax: 931-526-6712
Mailing address:
  • Phone: 931-526-6711
  • Fax: 931-526-6712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RALPH H. MULLINS JR.
Title or Position: CHIEF MANAGER
Credential: O.D.
Phone: 931-526-6711