Provider Demographics
NPI:1417193889
Name:WILLIAM J. TULLO, OD, LLC
Entity Type:Organization
Organization Name:WILLIAM J. TULLO, OD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:TULLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:609-921-6620
Mailing Address - Street 1:301 N HARRISON ST
Mailing Address - Street 2:STE 9B
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3512
Mailing Address - Country:US
Mailing Address - Phone:609-921-6620
Mailing Address - Fax:
Practice Address - Street 1:301 N HARRISON ST
Practice Address - Street 2:STE 9B
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3512
Practice Address - Country:US
Practice Address - Phone:609-921-6620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00485801152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2035216700013OtherCIGNA
NJ0004481153OtherAETNA