Provider Demographics
NPI:1073117768
Name:JOHN MUELLER OD PC
Entity Type:Organization
Organization Name:JOHN MUELLER OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:920-645-3339
Mailing Address - Street 1:4190 VINEWOOD LN N STE 109
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-1771
Mailing Address - Country:US
Mailing Address - Phone:763-559-5522
Mailing Address - Fax:763-559-7122
Practice Address - Street 1:4190 VINEWOOD LN N STE 109
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-1771
Practice Address - Country:US
Practice Address - Phone:763-559-5522
Practice Address - Fax:763-559-7122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty