Provider Demographics
NPI:1750497012
Name:MULLIS EYE INSTITUTE INC
Entity Type:Organization
Organization Name:MULLIS EYE INSTITUTE INC
Other - Org Name:PHYSICIAN GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-763-6666
Mailing Address - Street 1:1600 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4644
Mailing Address - Country:US
Mailing Address - Phone:850-763-6666
Mailing Address - Fax:850-763-6665
Practice Address - Street 1:1600 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4644
Practice Address - Country:US
Practice Address - Phone:850-763-6666
Practice Address - Fax:850-763-6665
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MULLIS EYE INSTITUTE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-21
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251263700Medicaid
FL301351100Medicaid
FL251263700Medicaid
GACA5964Medicare PIN
FL21585Medicare PIN
FL301351100Medicaid