Provider Demographics
NPI:1487650354
Name:MULLIN, BERNARD (OD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:MULLIN
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 1:438 COUNTY ROAD 513
Mailing Address - Street 2:
Mailing Address - City:CALIFON
Mailing Address - State:NJ
Mailing Address - Zip Code:07830-4187
Mailing Address - Country:US
Mailing Address - Phone:908-832-9211
Mailing Address - Fax:908-832-5806
Practice Address - Street 1:438 COUNTY ROAD 513
Practice Address - Street 2:
Practice Address - City:CALIFON
Practice Address - State:NJ
Practice Address - Zip Code:07830-4187
Practice Address - Country:US
Practice Address - Phone:908-832-9211
Practice Address - Fax:908-832-5806
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00457800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0323608Medicaid
410034332OtherRAILROAD MEDICARE
NJ0287749OtherCIGNA
NJ4573646OtherAETNA PROVIDER ID
410015466OtherRAILROAD MEDICARE
410015466OtherRAILROAD MEDICARE
NJ0323608Medicaid