Provider Demographics
NPI:1013038405
Name:HULTMAN, SCOTT RANDALL (O,D)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RANDALL
Last Name:HULTMAN
Suffix:
Gender:M
Credentials:O,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8199 N SIERRA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0469
Mailing Address - Country:US
Mailing Address - Phone:559-325-8005
Mailing Address - Fax:
Practice Address - Street 1:3636 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-5304
Practice Address - Country:US
Practice Address - Phone:559-244-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10083152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist