Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TN635 | TN |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | TN635 | TN |
N | 152WX0102X | Occupational Vision | TN635 | TN |
NPI | 1366425605 |
---|---|
Provider Name | Ralph H Mullins |
First Address | Cookeville, TN 38501-1807 |
Second Address | Cookeville, TN 38501-1807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2005 |
Last Update Date | 26/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U25244 | (02) |