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General NPI Number Information
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NPI Number | 1922204007
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Entity Type | Organization
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Legal Business Name | TARA K. MULLEN, O.D., P.C.
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 07/31/2009
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Provider Practice Location Address
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Address Line | 4525 HIGHWAY 411 SUITE B
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City | MADISONVILLE
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State | TN
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Zip | 37354-1536
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Country | US
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Telephone | 423-442-8649
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Fax | 423-420-3441
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Provider Business Mailing Address
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Address Line | 4525 HIGHWAY 411 SUITE B
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City | MADISONVILLE
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State | TN
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Zip | 37354-1536
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Country | US
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Telephone | 423-442-8649
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Fax | 423-420-3441
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Authorized Official
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Title or Position | OWNER
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Name | DR. TARA K. MULLEN
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Credential | OPTOMETRIST
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Telephone | 423-442-8649
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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 | TN2011
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License Number State | TN
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