Provider Demographics
NPI:1972769040
Name:MULLEN, LAUREN KITZHOFFER (OD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:KITZHOFFER
Last Name:MULLEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:KITZHOFFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:485 ROUTE 1 S
Mailing Address - Street 2:BLDG A
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-3009
Mailing Address - Country:US
Mailing Address - Phone:732-750-0400
Mailing Address - Fax:732-602-0749
Practice Address - Street 1:485 ROUTE 1 S
Practice Address - Street 2:BLDG A
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-3009
Practice Address - Country:US
Practice Address - Phone:732-750-0400
Practice Address - Fax:732-602-0749
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00611800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
150281MP7Medicare PIN