Provider Demographics
NPI:1952508806
Name:MULLINS, STEPHEN RICH (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RICH
Last Name:MULLINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 BUCK LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-6302
Mailing Address - Country:US
Mailing Address - Phone:931-537-6112
Mailing Address - Fax:
Practice Address - Street 1:585 E 10TH ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1807
Practice Address - Country:US
Practice Address - Phone:931-526-6711
Practice Address - Fax:931-526-6712
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2733152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist