Provider Demographics
NPI:1710128459
Name:TULLY C. PATROWICZ MD,PL
Entity Type:Organization
Organization Name:TULLY C. PATROWICZ MD,PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR - OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TULLY
Authorized Official - Middle Name:COLCORD
Authorized Official - Last Name:PATROWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-357-3851
Mailing Address - Street 1:8900 SE 165TH MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5884
Mailing Address - Country:US
Mailing Address - Phone:352-357-3851
Mailing Address - Fax:
Practice Address - Street 1:8900 SE 165TH MULBERRY LN
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5884
Practice Address - Country:US
Practice Address - Phone:352-674-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME14662261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1710128459Medicare PIN