1255515912 NPI number — ROBERT MULGREW CORPORATION

Table of content: (NPI 1255515912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255515912 NPI number — ROBERT MULGREW CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT MULGREW CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AFFINITY EYE CARE GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255515912
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/31/2018
NPI Reactivation Date:
09/17/2018

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6615 N ORACLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85704-5644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-797-8000
Provider Business Mailing Address Fax Number:
520-797-8008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6615 N ORACLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85704-5644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-797-8000
Provider Business Practice Location Address Fax Number:
520-797-8008
Provider Enumeration Date:
12/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MULGREW
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
HARRISON
Authorized Official Title or Position:
OWNER/OPTOMETRIST
Authorized Official Telephone Number:
520-797-8000

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  708 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)