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General NPI Number Information
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NPI Number | 1407871296
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Entity Type | Individual
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Provider Name | SEAN P MULQUEENY OD
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Gender | Male
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 612 N NEW BALLAS ROAD
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City | CREVE COEUR
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State | MO
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Zip | 63141-6714
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Country | US
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Telephone | 314-542-3600
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Fax | 314-542-4041
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Provider Business Mailing Address
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Address Line | 612 N NEW BALLAS RD
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City | CREVE COEUR
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State | MO
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Zip | 63141-6714
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Country | US
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Telephone | 314-542-3600
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Fax | 314-542-4041
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | T03017
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License Number State | MO
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