Provider Demographics
NPI:1356344618
Name:MULDOON, SHAWN (OD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:MULDOON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5874 WESTHEIMER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-5641
Mailing Address - Country:US
Mailing Address - Phone:713-974-2020
Mailing Address - Fax:713-975-9756
Practice Address - Street 1:5874 WESTHEIMER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5641
Practice Address - Country:US
Practice Address - Phone:713-974-2020
Practice Address - Fax:713-975-9756
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5004TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041116701Medicaid
TX041116702Medicaid
TX041116702Medicaid
TX8F24115Medicare PIN
TX82984EMedicare PIN