Provider Demographics
NPI:1396000352
Name:ULLMANN, SCOTT (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:ULLMANN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1318 N ROSELLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3646
Mailing Address - Country:US
Mailing Address - Phone:847-278-3888
Mailing Address - Fax:847-278-3890
Practice Address - Street 1:1318 N ROSELLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-3646
Practice Address - Country:US
Practice Address - Phone:847-278-3888
Practice Address - Fax:847-278-3890
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL046010578152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist