Active NPI
Anita Mullins
- Optometrist
- Fairbanks, AK
National Provider Identifier
1114935616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 216
- Practice address
- 201 Old Steese Hwy Ste 2
Fairbanks, AK 99701-3160 - Phone
- (907) 456-4822
- Fax
- (907) 456-4830
- NPI assigned
- Aug 3, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 216 | AK | Primary |
Addresses
Primary practice location
201 Old Steese Hwy Ste 2
Fairbanks, AK 99701-3160
Mailing address
1585 Pennyweight Dr
Fairbanks, AK 99712-4000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OD9415 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 216 | AK | MD | Mental Health Counselor |
| 654 | MT | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Samuel a McConkey III MD PC | Past | Accepting new patients | |
| Samuel a McConkey III MD PC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Ophthalmology Physician
- Fairbanks, AK
- NPI 1578601340
-
- Ophthalmology Physician
- Glendale, AZ
- NPI 1134315757
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114935616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1585 PENNYWEIGHT DR",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997124000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 OLD STEESE HWY STE 2",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997013160",
"telephone_number": "907-456-4822",
"fax_number": "907-456-4830"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLINS",
"first_name": "ANITA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AK",
"license": "216",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "OD9415",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.