Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XL0004X | Low Vision | 121173 | TX |
NPI | 1417539495 |
---|---|
Provider Name | Ms. Carmen Mullins |
First Address | Houston, TX 77007-2848 |
Second Address | Houston, TX 77030-1526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2021 |
Last Update Date | 28/04/2021 |