Provider Demographics
NPI:1346318003
Name:ELIZABETH R MULLETT & ASSOCIATES OD PLLC
Entity Type:Organization
Organization Name:ELIZABETH R MULLETT & ASSOCIATES OD PLLC
Other - Org Name:PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:REID
Authorized Official - Last Name:MULLETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:252-758-2100
Mailing Address - Street 1:2573 STANTONSBURG RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834
Mailing Address - Country:US
Mailing Address - Phone:252-758-2100
Mailing Address - Fax:252-758-2103
Practice Address - Street 1:2573 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834
Practice Address - Country:US
Practice Address - Phone:252-758-2100
Practice Address - Fax:252-758-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1503152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909653Medicaid
NC8909653Medicaid
NC2430443Medicare PIN
NC5344860001Medicare NSC