Provider Demographics
NPI:1164590303
Name:BULOS, ARNOLD (OD)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:
Last Name:BULOS
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 1:3916 STEAMBOAT CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-9324
Mailing Address - Country:US
Mailing Address - Phone:734-769-5777
Mailing Address - Fax:
Practice Address - Street 1:856 BRIARWOOD CIR
Practice Address - Street 2:BRIARWOOD MALL
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1616
Practice Address - Country:US
Practice Address - Phone:734-761-8300
Practice Address - Fax:734-769-1018
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003799152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN26930122Medicare PIN