Provider Demographics
NPI:1891862231
Name:DULL, THOMAS WARNER (OD OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WARNER
Last Name:DULL
Suffix:
Gender:M
Credentials:OD OPTOMETRIST
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Mailing Address - Street 1:1850 ADAM ST SUITE 005 SEARS OPTICAL
Mailing Address - Street 2:THOMAS W DULL
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001
Mailing Address - Country:US
Mailing Address - Phone:507-389-4468
Mailing Address - Fax:507-388-4397
Practice Address - Street 1:1850 ADAM ST SUITE 005 SEARS OPTICAL
Practice Address - Street 2:THOMAS W DULL
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-389-4468
Practice Address - Fax:507-388-4397
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2008-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN1340152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5C680DUOtherBCBS
MN2202443OtherMEDICA
MN5C680DUOtherBCBS
U48613Medicare UPIN