Provider Demographics
NPI:1275723744
Name:CULINA, TOM K (OD)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:K
Last Name:CULINA
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 1:4516 I 75 BUSINESS SPUR
Mailing Address - Street 2:WALMART VISION CENTER
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-9184
Mailing Address - Country:US
Mailing Address - Phone:906-632-0588
Mailing Address - Fax:906-632-0661
Practice Address - Street 1:4516 I 75 BUSINESS SPUR
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-9184
Practice Address - Country:US
Practice Address - Phone:906-632-0588
Practice Address - Fax:906-632-0661
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004053152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION53120Medicare PIN
MIU91230Medicare UPIN