Active NPI
Johnna A Mullen, LO
- Optician
- Shelton, CT
National Provider Identifier
1871880583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 1157
- Practice address
- 465 Bridgeport CT
Shelton, CT 06484 - Phone
- (203) 926-1189
- NPI assigned
- Jul 1, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 1157 | CT | Primary |
Addresses
Primary practice location
465 Bridgeport CT
Shelton, CT 06484
Mailing address
31 Moose Hill Rd
Oxford, CT 06478
Phone (203) 888-5584
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1157 | CT | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309478400000",
"number": "1871880583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 MOOSE HILL RD",
"city": "OXFORD",
"state": "CT",
"postal_code": "06478",
"telephone_number": "203-888-5584"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "465 BRIDGEPORT CT",
"city": "SHELTON",
"state": "CT",
"postal_code": "06484",
"telephone_number": "203-926-1189"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLEN",
"first_name": "JOHNNA",
"middle_name": "A",
"credential": "LO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-01",
"last_updated": "2011-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "CT",
"license": "1157",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shelton, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.