Scott David Mullane, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

532 Issued in AZ

Practice address

1925 Florence Ave
Kingman, AZ 86401-4617

Phone

(928) 753-2106

Fax

(928) 753-4283

NPI assigned

Nov 15, 2005

Last updated

Dec 22, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292976000000",
    "number": "1447232590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 FLORENCE AVE",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864014617",
            "telephone_number": "928-753-2106",
            "fax_number": "928-753-4283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 FLORENCE AVE",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864014617",
            "telephone_number": "928-753-2106",
            "fax_number": "928-753-4283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLANE",
        "first_name": "SCOTT",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-15",
        "last_updated": "2010-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410036220",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Kingman, AZ
• Providers in Kingman, AZ by specialty
• Optometrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.