Provider Demographics
NPI:1508430042
Name:MULLINS, NICHOLAS HARDING (OD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:HARDING
Last Name:MULLINS
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 1:1609 GILMER AVE
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-2343
Mailing Address - Country:US
Mailing Address - Phone:334-283-6535
Mailing Address - Fax:
Practice Address - Street 1:1609 GILMER AVE
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-2343
Practice Address - Country:US
Practice Address - Phone:334-283-6535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-E79-TA-C18152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist