Provider Demographics
NPI:1437111200
Name:MULIS, JAMES
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:MULIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-1027
Mailing Address - Country:US
Mailing Address - Phone:765-472-4344
Mailing Address - Fax:765-472-7095
Practice Address - Street 1:935 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-1027
Practice Address - Country:US
Practice Address - Phone:765-472-4344
Practice Address - Fax:765-472-7095
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001608A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100179280Medicaid
T34908Medicare UPIN
INP00271478Medicare PIN
IN100179280Medicaid
IN160450029Medicare PIN
INP00431147Medicare PIN
IN228900AMedicare PIN