Basic Information
Provider Information | |||||||||
NPI: | 1790794154 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MULIER | ||||||||
FirstName: | KATHY | ||||||||
MiddleName: | G | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | O.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6401 UNIVERSITY AVE NE | ||||||||
Address2: | SUITE 200 | ||||||||
City: | FRIDLEY | ||||||||
State: | MN | ||||||||
PostalCode: | 554324341 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7635725710 | ||||||||
FaxNumber: | 7635713008 | ||||||||
Practice Location | |||||||||
Address1: | 13819 HANSON BLVD NW | ||||||||
Address2: |   | ||||||||
City: | ANDOVER | ||||||||
State: | MN | ||||||||
PostalCode: | 553047608 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7635725710 | ||||||||
FaxNumber: | 7638624490 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/05/2006 | ||||||||
LastUpdateDate: | 04/02/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2542 | MN | Y |   | Eye and Vision Services Providers | Optometrist |   |
ID Information
ID | Type | State | Issuer | Description | 5885414 | 01 | MN | AETNA | OTHER | 115621 | 01 | MN | UCARE MN | OTHER | HP20812 | 01 | MN | HEALTHPARTNERS | OTHER | 08F81MU | 01 | MN | BCBS OF MN | OTHER | 2200397 | 01 | MN | MEDICA NUMBER | OTHER | 765923 | 01 | MN | AMERICA'S PPO | OTHER | 1012433 | 01 | MN | PREFERRED ONE | OTHER | 442219800 | 05 | MN |   | MEDICAID |