Provider Demographics
NPI:1619005832
Name:ULLMAN, MARC (OD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:ULLMAN
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 1:90 ATLANTIC CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:PINE BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08741-1545
Mailing Address - Country:US
Mailing Address - Phone:732-736-1700
Mailing Address - Fax:
Practice Address - Street 1:90 ATLANTIC CITY BLVD
Practice Address - Street 2:
Practice Address - City:PINE BEACH
Practice Address - State:NJ
Practice Address - Zip Code:08741-1545
Practice Address - Country:US
Practice Address - Phone:732-736-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00554700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU73959Medicare UPIN