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NPI Code Detail

MEDICARE: MULLIS EYE INSTITUTE INC

MEDICARE: MULLIS EYE INSTITUTE INC
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
1261QA1903XAmbulatory Surgical Clinic/Center948FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578575064
Entity Type Code : Organization
Provider Name (Legal Business Name) : MULLIS EYE INSTITUTE INC
Provider Business Mailing Address
First Line : 1600 JENKS AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4644
Country : US
Telephone Number : 850-763-6666
Fax Number : 850-763-6665
Provider Business Practice Location Address
First Line : 1600 JENKS AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4644
Country : US
Telephone Number : 850-763-6666
Fax Number : 850-763-6665
Authorized Official
Title or Position : VICE PRESIDENT
Name : DARREN PAYNE
Credential : M.D.
Telephone Number : 850-763-6666
Provider Enumeration Date : 08/12/2006
Last Update Date : 11/11/2014

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Directions to “MULLIS EYE INSTITUTE INC ” Practice Location

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