Provider Demographics
NPI:1851344972
Name:TOWNSEND-MULLIN, MICHELLE RENEE (OD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:TOWNSEND-MULLIN
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 1:409 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-8003
Mailing Address - Country:US
Mailing Address - Phone:215-860-3400
Mailing Address - Fax:215-860-8779
Practice Address - Street 1:409 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-8003
Practice Address - Country:US
Practice Address - Phone:215-860-3400
Practice Address - Fax:215-860-8779
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000357152W00000X
NJ27TO00120700152W00000X
NJ27OA00580700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
233004476OtherDEVON
PAT0895511OtherBC/BS
2422650OtherAETNA
PA410046373OtherRAILROAD MEDICARE
PA2821078001OtherCIGNA
P2784794OtherOXFORD
P2784794OtherOXFORD
NJ109311VSPMedicare PIN
NJ109311VSPMedicare PIN