NPIMap

Organization Active NPI

Elizabeth R Mullett & Associates OD PLLC

  • Optometrist
  • Greenville, NC
National Provider Identifier
1346318003
Registry record updated Aug 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1503 Issued in NC
Legal business name
ELIZABETH R MULLETT & ASSOCIATES OD PLLC
Practice address
2573 Stantonsburg Rd
Greenville, NC 27834
Phone
(252) 758-2100
Fax
(252) 758-2103
NPI assigned
Dec 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2012

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

Authorized official

Name
Dr. Elizabeth Reid Mullett, OD
Title
Optometrist Member Manager
Phone
(252) 758-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1503 NC Primary

Addresses

Primary practice location

2573 Stantonsburg Rd
Greenville, NC 27834

Mailing address

2573 Stantonsburg Rd
Greenville, NC 27834
Phone (252) 758-2100

Other identifiers 1

IdentifierTypeStateIssuer
8909653MedicaidNC

Other names 1

  • PLLC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930044615 NC DME Supplier - Physician - Optometrist 9739141029 Practice locations: Greenville, NC

National Provider Directory

National Provider Directory

Locations

702 Johns Hopkins Dr
Greenville, NC 27834
Phone (252) 757-0123

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346025600000",
    "number": "1346318003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2573 STANTONSBURG RD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "27834",
            "telephone_number": "252-758-2100",
            "fax_number": "252-758-2103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2573 STANTONSBURG RD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "27834",
            "telephone_number": "252-758-2100",
            "fax_number": "252-758-2103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIZABETH R MULLETT & ASSOCIATES OD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2012-08-27",
        "status": "A",
        "authorized_official_last_name": "MULLETT",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "REID",
        "authorized_official_title_or_position": "OPTOMETRIST MEMBER MANAGER",
        "authorized_official_telephone_number": "252-758-2100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8909653",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PLLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Greenville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2012; 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.