Jerry L. Mullen, O.D., P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

963 Issued in OK

Legal business name

JERRY L. MULLEN, O.D., P.C.

Practice address

7101 NW Expressway
#130
Oklahoma City, OK 73132-1584

Phone

(405) 721-7450

Fax

(405) 721-7491

NPI assigned

May 16, 2007

Organization subpart

No

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

Authorized official

Name

Jerry Lee Mullen, O.D.NPI 1619073749

Title

President

Phone

(405) 721-7450

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jerry Lee Mullen, O.D.

  • Optometrist
  • Oklahoma City, OK
  • NPI 1619073749
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222214400000",
    "number": "1285841601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7101 NW EXPRESSWAY",
            "address_2": "#130",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731321584",
            "telephone_number": "405-721-7450",
            "fax_number": "405-721-7491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7101 NW EXPRESSWAY",
            "address_2": "#130",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731321584",
            "telephone_number": "405-721-7450",
            "fax_number": "405-721-7491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY L. MULLEN, O.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2008-09-24",
        "status": "A",
        "authorized_official_last_name": "MULLEN",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-721-7450",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OK",
            "license": "963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200083220A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00068003",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200083220B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Jerichow, APRN-CNP
• Carla Louise Jernigan, RSS, WELLNESS COACH
• Claudia Jernigan
• Julia Nicole Jernigan, BHRS/PRS
• Tracey Lea Jernigan, LCSW
• Jerry R. Teel, PHD PC
• Leah Marie Jeryc
• Christina Ann Jester
• Jamie Claire Jester
• Matthew Rawlins Jester, MD

• Optometrist in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Optometrist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.