Provider Demographics
NPI:1659369809
Name:MULHERN, KELLI PRICE (OD)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:PRICE
Last Name:MULHERN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:KELLI
Other - Middle Name:PRICE
Other - Last Name:CHAWLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:77 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-3104
Mailing Address - Country:US
Mailing Address - Phone:740-773-8055
Mailing Address - Fax:740-773-8057
Practice Address - Street 1:77 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3104
Practice Address - Country:US
Practice Address - Phone:740-773-8055
Practice Address - Fax:740-773-8057
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH5089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2196421Medicaid
OH410041535Medicare PIN
OH6038580001Medicare NSC
OH2196421Medicaid
OH4041329Medicare PIN
OH0899776Medicare PIN
OH0899775Medicare PIN
OHU78728Medicare UPIN