Provider Demographics
NPI:1427191170
Name:MULLIIKIN, LEE (OD)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:
Last Name:MULLIIKIN
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 1:1245 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5932
Mailing Address - Country:US
Mailing Address - Phone:805-543-0288
Mailing Address - Fax:805-543-0288
Practice Address - Street 1:200 TOWN CTR E
Practice Address - Street 2:SEARS OPTICAL
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5131
Practice Address - Country:US
Practice Address - Phone:805-922-0990
Practice Address - Fax:805-928-5779
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8814T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist