Kendall Clark Mullins, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT001400 Issued in GA

Practice address

9220 Marne Rd
Fort Moore, GA 31905-5515

Phone

(706) 682-3938

Fax

(706) 682-3931

NPI assigned

Feb 16, 2007

Last updated

May 23, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, AL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Optometry

Education

University Alabama Birmingham - School of Optometry, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eyecare Associates, Inc.Group PAC ID 0749254001, 52 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kendallmullins@direct.eyecare-partners.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eyecare Associates, Inc.

  • Eyewear Supplier
  • Birmingham, AL
  • NPI 1710012877

  Optometrist

  Medicare reassignment Care Compare group NPD
• Southside Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Atlanta, GA
  • NPI 1235123993
  Medicare reassignment NPD
• Calera Vision Center, LLC

  • Optometrist
  • Calera, AL
  • NPI 1437486107
  Authorized official Same address or phone
• Southside Medical Center, Inc

  dba Southside Medical Center School Based Health Center at Lee Elementary School

  • Federally Qualified Health Center (FQHC)
  • Jonesboro, GA
  • NPI 1821981234
  NPD
• Eyecare Associates, Inc.

  dba Eyecare Associates -Montgomery 4320

  • Optometrist
  • Montgomery, AL
  • NPI 1871475038
  NPD
• Eyecare Associates, Inc.

  • Optometrist
  • Prattville, AL
  • NPI 1902902463
  NPD
• Eyecare Associates, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Jasper, AL
  • NPI 1255490041
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716422400000",
    "number": "1144364043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 COUNTY ROAD 941",
            "city": "CLANTON",
            "state": "AL",
            "postal_code": "350457979",
            "telephone_number": "205-585-6461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9220 MARNE RD",
            "city": "FORT MOORE",
            "state": "GA",
            "postal_code": "319055515",
            "telephone_number": "706-682-3938",
            "fax_number": "706-682-3931"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1735 East Main Street",
            "address_purpose": "LOCATION",
            "city": "Prattville",
            "state": "AL",
            "postal_code": "360665515",
            "country_code": "US",
            "telephone_number": "334-358-2188",
            "fax_number": "334-358-0766",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8436 Vaughn Road",
            "address_purpose": "LOCATION",
            "city": "Montgomery",
            "state": "AL",
            "postal_code": "361175515",
            "country_code": "US",
            "telephone_number": "334-271-3900",
            "fax_number": "334-271-3915",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100 Lay Dam",
            "address_purpose": "LOCATION",
            "city": "Clanton",
            "state": "AL",
            "postal_code": "350455515",
            "country_code": "US",
            "telephone_number": "205-755-1351",
            "fax_number": "205-755-0351",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MULLINS",
        "first_name": "KENDALL",
        "middle_name": "CLARK",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-16",
        "last_updated": "2024-05-23",
        "certification_date": "2022-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S-779-TA-718",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT001400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juan Daniel Mendoza, MD
• Yolanda Maria Miroballi Mendoza, MD
• Montgomery Vamc
• Clint J Moore, D.O.
• Christian Louis Morzinski, DO
• Ross Murphy
• Ryann Mae Murphy
• Meredith Myatt, NP STUDENT
• Radhakrishnan Narasimhan, M.D.
• Jennifer Suzanne Neal, OTR/L

• Optometrist in Fort Moore, GA
• Providers in Fort Moore, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.