Provider Demographics
NPI:1831182252
Name:MULLETT, ELIZABETH REID (OD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:REID
Last Name:MULLETT
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 1:2573 STANTONSBURG RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7213
Mailing Address - Country:US
Mailing Address - Phone:258-275-8210
Mailing Address - Fax:252-758-2103
Practice Address - Street 1:2573 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7213
Practice Address - Country:US
Practice Address - Phone:258-275-8210
Practice Address - Fax:252-758-2103
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1503152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909653Medicaid
NC5344860001OtherCIGNA/DMERC PROVIDER ID
U46997Medicare UPIN
NC8909653Medicaid
NC2340443Medicare PIN