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General NPI Number Information
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NPI Number | 1265588602
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Entity Type | Organization
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Legal Business Name | GERALD W. MCMULLIN, O.D., INC.
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 09/03/2009
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Provider Practice Location Address
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Address Line | 922 S MAIN ST
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City | KINGFISHER
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State | OK
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Zip | 73750-4416
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Country | US
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Telephone | 405-375-3128
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Fax |
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Provider Business Mailing Address
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Address Line | 922 S MAIN ST
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City | KINGFISHER
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State | OK
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Zip | 73750-4416
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GERALD W. MCMULLIN
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Credential | O.D.
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Telephone | 405-375-3128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 996
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License Number State | OK
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