Organization
JERRY L. MULLEN, O.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY LEE MULLEN O.D. (PRESIDENT)
(405) 721-7450
Entity
Organization
Contact information
Practice address
7101 NW EXPRESSWAY, #130, OKLAHOMA CITY, OK 73132-1584
(405) 721-7450
(405) 721-7491
Mailing address
7101 NW EXPRESSWAY, #130, OKLAHOMA CITY, OK 73132-1584
(405) 721-7450
(405) 721-7491
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
963
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200083220A
—
OK
05
—
200083220B
—
OK
01
—
P00068003
MEDICARE RAILROAD
OK
Enumeration date
05/16/2007
Last updated
09/24/2008
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