Organization
GERALD W. MCMULLIN, O.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD W. MCMULLIN O.D. (PRESIDENT)
(405) 375-3128
Entity
Organization
Contact information
Practice address
922 S MAIN ST, KINGFISHER, OK 73750-4416
(405) 375-3128
Mailing address
922 S MAIN ST, KINGFISHER, OK 73750-4416
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
996
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100766080A
—
OK
Enumeration date
01/26/2007
Last updated
09/03/2009
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