Provider Demographics
NPI:1972141877
Name:MULLINS VISION SOUTH, PLLC
Entity Type:Organization
Organization Name:MULLINS VISION SOUTH, PLLC
Other - Org Name:MULLINS VISION SPARTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:931-252-0830
Mailing Address - Street 1:126 E. BOCKMAN WAY
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583
Mailing Address - Country:US
Mailing Address - Phone:931-252-0830
Mailing Address - Fax:
Practice Address - Street 1:126 E BOCKMAN WAY
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-2036
Practice Address - Country:US
Practice Address - Phone:931-836-2235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty