Healthcare Provider Details

I. General information

NPI: 1972141877
Provider Name (Legal Business Name): MULLINS VISION SOUTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 E BOCKMAN WAY
SPARTA TN
38583-2036
US

IV. Provider business mailing address

126 E. BOCKMAN WAY
SPARTA TN
38583
US

V. Phone/Fax

Practice location:
  • Phone: 931-836-2235
  • Fax:
Mailing address:
  • Phone: 931-252-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN R MULLINS
Title or Position: OWNER/PROVIDER
Credential: OD
Phone: 931-252-0830