Provider Demographics
NPI:1346305612
Name:MULVEY, RAYMOND (OD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:MULVEY
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 1:7780 N FRESNO ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2413
Mailing Address - Country:US
Mailing Address - Phone:559-435-2060
Mailing Address - Fax:559-435-9060
Practice Address - Street 1:7780 N FRESNO ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2413
Practice Address - Country:US
Practice Address - Phone:559-435-2060
Practice Address - Fax:559-435-9060
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 8816T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0088161Medicaid
CASD0088160Medicaid
CASD0088160Medicaid
CASD0088160Medicare PIN
CASD0088161Medicare PIN
CAU22961Medicare UPIN