Provider Demographics
NPI:1316139371
Name:MCMULLEN, WILLIAM VIRGIL (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:VIRGIL
Last Name:MCMULLEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5965 W RAY ROAD
Mailing Address - Street 2:SUITE 26
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226
Mailing Address - Country:US
Mailing Address - Phone:480-940-3222
Mailing Address - Fax:480-940-9946
Practice Address - Street 1:5965 W RAY RD
Practice Address - Street 2:SUITE 26
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-1829
Practice Address - Country:US
Practice Address - Phone:480-940-3222
Practice Address - Fax:480-940-9946
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ149152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist