Provider Demographics
NPI:1255515912
Name:ROBERT MULGREW CORPORATION
Entity type:Organization
Organization Name:ROBERT MULGREW CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:MULGREW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:520-797-8000
Mailing Address - Street 1:6615 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5644
Mailing Address - Country:US
Mailing Address - Phone:520-797-8000
Mailing Address - Fax:520-797-8008
Practice Address - Street 1:6615 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5644
Practice Address - Country:US
Practice Address - Phone:520-797-8000
Practice Address - Fax:520-797-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2019-03-19
Deactivation Date:2018-08-31
Deactivation Code:
Reactivation Date:2018-09-17
Provider Licenses
StateLicense IDTaxonomies
AZ708152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT76787Medicare UPIN
AZ109186Medicare PIN