Provider Demographics
NPI:1538123765
Name:DULOS, THOMAS GREGORY (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GREGORY
Last Name:DULOS
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 1:1302 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-3527
Mailing Address - Country:US
Mailing Address - Phone:785-242-3707
Mailing Address - Fax:
Practice Address - Street 1:1302 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3527
Practice Address - Country:US
Practice Address - Phone:785-242-3707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS 1167-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100217840BMedicaid
T43636Medicare UPIN
KS100217840BMedicaid