Provider Demographics
NPI:1609853019
Name:MUELLER, MARILYN MACALOS (OD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:MACALOS
Last Name:MUELLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 VALLEY BROOK LN
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-7026
Mailing Address - Country:US
Mailing Address - Phone:832-443-0721
Mailing Address - Fax:
Practice Address - Street 1:4527 BASTOGNE
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-5110
Practice Address - Country:US
Practice Address - Phone:832-443-0721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6405TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609853019OtherNONE