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General NPI Number Information
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NPI Number | 1972141877
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Entity Type | Organization
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Legal Business Name | MULLINS VISION SOUTH, PLLC
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Dates
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Enumeration Date | 12/11/2019
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 126 E BOCKMAN WAY
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City | SPARTA
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State | TN
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Zip | 38583-2036
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Country | US
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Telephone | 931-836-2235
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Fax |
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Provider Business Mailing Address
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Address Line | 126 E. BOCKMAN WAY
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City | SPARTA
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State | TN
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Zip | 38583
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Country | US
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Telephone | 931-252-0830
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | STEPHEN R MULLINS
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Credential | OD
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Telephone | 931-252-0830
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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 |
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License Number State |
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