Provider Demographics
NPI:1164589230
Name:MULLINS, STEVEN PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PAUL
Last Name:MULLINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 DELTA WATERS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9175
Mailing Address - Country:US
Mailing Address - Phone:541-245-6856
Mailing Address - Fax:541-245-0734
Practice Address - Street 1:1740 DELTA WATERS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9175
Practice Address - Country:US
Practice Address - Phone:541-245-6856
Practice Address - Fax:541-245-0734
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1603T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226305Medicaid
OR226305Medicaid
ORU06232Medicare UPIN