Provider Demographics
NPI:1447367883
Name:MULLINS, PARIS JR (OD)
Entity type:Individual
Prefix:
First Name:PARIS
Middle Name:
Last Name:MULLINS
Suffix:JR
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 1:1609 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-589-TA-064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
13567OtherSPECTERA
630920769OtherVIVA HEALTH CARE
51059845OtherBCBS OF ALABAMA
0127960001OtherCIGNA HEALTH CARE
AP002263OtherHEALTH SPRING OF AL
AL000059845Medicaid
2210153OtherUNITED HEALTH CARE
630920769OtherHUMANA VISION CARE PLAN
630920769OtherVSP
630920769OtherVSP
AL000059845Medicaid
630920769OtherHUMANA VISION CARE PLAN