Provider Demographics
NPI:1366425605
Name:MULLINS, RALPH H (OD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:H
Last Name:MULLINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1807
Mailing Address - Country:US
Mailing Address - Phone:931-526-6711
Mailing Address - Fax:931-526-6712
Practice Address - Street 1:585 E 10TH ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1807
Practice Address - Country:US
Practice Address - Phone:931-526-6711
Practice Address - Fax:931-526-6712
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN635152W00000X, 152WC0802X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
U25244Medicare UPIN
3594278Medicare ID - Type Unspecified