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NPI Code Detail

MEDICARE: DR. TITIA MULDER OD

MEDICARE:  DR. TITIA  MULDER  OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist2000144120MO

General Provider Information

NPI Number : 1396886354
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TITIA MULDER OD
Provider Business Mailing Address
First Line : 10275 WATSON RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63127-1103
Country : US
Telephone Number : 314-909-9975
Fax Number : 314-835-0284
Provider Business Practice Location Address
First Line : 10275 WATSON RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63127-1103
Country : US
Telephone Number : 314-909-9975
Fax Number : 314-835-0284
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2007
Last Update Date : 02/22/2016

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Directions to “ DR. TITIA MULDER OD” Practice Location

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