Provider Demographics
NPI:1568428795
Name:STEPHEN M PULLEN PA
Entity Type:Organization
Organization Name:STEPHEN M PULLEN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MCAFEE
Authorized Official - Last Name:PULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-262-2249
Mailing Address - Street 1:11808-1 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223
Mailing Address - Country:US
Mailing Address - Phone:904-262-2249
Mailing Address - Fax:904-268-8283
Practice Address - Street 1:11808-1 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223
Practice Address - Country:US
Practice Address - Phone:904-262-2249
Practice Address - Fax:904-268-8283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74964OtherBCBS
FL74964OtherBCBS
FLK5874Medicare PIN