Provider Demographics
NPI:1326216631
Name:CLAUDE DANIEL MCMULLEN
Entity Type:Organization
Organization Name:CLAUDE DANIEL MCMULLEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:MCMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-393-1259
Mailing Address - Street 1:8982 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-3850
Mailing Address - Country:US
Mailing Address - Phone:727-393-1259
Mailing Address - Fax:727-399-2175
Practice Address - Street 1:8982 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-3850
Practice Address - Country:US
Practice Address - Phone:727-393-1259
Practice Address - Fax:727-399-2175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC897152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0668660001Medicare NSC
T83972Medicare UPIN