NPIMap

Individual provider Active NPI

Mark Pulliam, OD

  • Optometrist
  • Clarksville, IN
National Provider Identifier
1376608943
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18002185 Issued in IN
Practice address
516 E Lewis and Clark Pkwy
Clarksville, IN 47129-1700
Phone
(812) 282-2020
Fax
(812) 288-2807
NPI assigned
Dec 26, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18002185 IN Primary
Optometrist 152W00000X 1024DT KY

Addresses

Primary practice location

516 E Lewis and Clark Pkwy
Clarksville, IN 47129-1700

Mailing address

11103 West Ave
Suite 6
San Antonio, TX 78213-1370
Phone (210) 524-6663

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18002185INMDOptometrist
1024DTKYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients
Tri-State Doctors of Optometrist Past Accepting new patients
Ky Doctors of Optometry, PLLC Past Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients
Tri-State Doctors of Optometrist Past Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients
Ky Doctors of Optometry, PLLC Optometrist Past Accepting new patients
Ky Doctors of Optometry, PLLC Past Accepting new patients

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1376608943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11103 WEST AVE",
            "address_2": "SUITE 6",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782131370",
            "telephone_number": "210-524-6663",
            "fax_number": "210-524-6587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 E LEWIS AND CLARK PKWY",
            "city": "CLARKSVILLE",
            "state": "IN",
            "postal_code": "471291700",
            "telephone_number": "812-282-2020",
            "fax_number": "812-288-2807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PULLIAM",
        "first_name": "MARK",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-26",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002185",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1024DT",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, IN

Sources for this page

Verify at the official NPI Registry.