Provider Demographics
NPI:1104013960
Name:MULAC, MAUREEN A (OD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:A
Last Name:MULAC
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MAUREEN
Other - Middle Name:A
Other - Last Name:GERAGHTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4313 WALNUT ST
Mailing Address - Street 2:SEARS OPTICAL
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132
Mailing Address - Country:US
Mailing Address - Phone:412-754-1052
Mailing Address - Fax:412-754-1053
Practice Address - Street 1:4313 WALNUT ST
Practice Address - Street 2:SEARS OPTICAL
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132
Practice Address - Country:US
Practice Address - Phone:412-754-1052
Practice Address - Fax:412-754-1053
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001240152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01818809Medicaid
PAU67428Medicare UPIN
PAGE000831Medicare PIN