Provider Demographics
NPI:1922767136
Name:MAGNOLIA PLACE EYECARE LLC
Entity Type:Organization
Organization Name:MAGNOLIA PLACE EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:334-283-6535
Mailing Address - Street 1:1609 GILMER AVE
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-2343
Mailing Address - Country:US
Mailing Address - Phone:334-283-6535
Mailing Address - Fax:334-283-5996
Practice Address - Street 1:1609 GILMER AVE
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-2343
Practice Address - Country:US
Practice Address - Phone:334-283-6535
Practice Address - Fax:334-283-5996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty