Provider Demographics
NPI:1790478949
Name:MULLINS, JOHN STEWART (LDO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:STEWART
Last Name:MULLINS
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 CHATTANOOGA PLZ
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4865
Mailing Address - Country:US
Mailing Address - Phone:804-744-8132
Mailing Address - Fax:
Practice Address - Street 1:12200 CHATTANOOGA PLZ
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4865
Practice Address - Country:US
Practice Address - Phone:804-744-8132
Practice Address - Fax:804-744-8198
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101002896156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician