Provider Demographics
NPI:1154508109
Name:THOMAS S. GULLOTTI,O.D.
Entity Type:Organization
Organization Name:THOMAS S. GULLOTTI,O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:GULLOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:716-484-0325
Mailing Address - Street 1:560 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-4776
Mailing Address - Country:US
Mailing Address - Phone:716-484-0325
Mailing Address - Fax:716-484-0343
Practice Address - Street 1:560 W 3RD ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-4776
Practice Address - Country:US
Practice Address - Phone:716-484-0325
Practice Address - Fax:716-484-0343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV3647332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY410019717Medicare PIN
NY0246470002Medicare NSC