Provider Demographics
NPI:1265510671
Name:BULAS, NANCY M (OD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:BULAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8024 STATE RT 12
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:NY
Mailing Address - Zip Code:13304
Mailing Address - Country:US
Mailing Address - Phone:315-896-3900
Mailing Address - Fax:315-896-3905
Practice Address - Street 1:8024 STATE RT 12
Practice Address - Street 2:
Practice Address - City:BARNEVELD
Practice Address - State:NY
Practice Address - Zip Code:13304
Practice Address - Country:US
Practice Address - Phone:315-896-3900
Practice Address - Fax:315-896-3905
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0048421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RB4091Medicare PIN
U22413Medicare UPIN