Doctor Name: | SUSAN M MULLEN |
NPI Number: | 1013147966 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 007229-1 |
Business Practice Address: | 152 Bay St Glens Falls, NY - 128012329 |
Business Phone Number: | 5187924140 |
Business Fax Number: | 5187929008 |
Mailing Address: | 152 Bay St, GLENS FALLS |
State: | NY |
Postal Code: | 128012329 |
Phone Number: | 5187924140 |
Fax Number: | 5187929008 |
NPI Enumeration Date: | 07/24/2009 |
NPI Last Update Date: | 04/16/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | 007229-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |