Provider Demographics
NPI:1457377624
Name:TULLO, WILLIAM J (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:TULLO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:211 N. HARRISON STREET
Mailing Address - Street 2:STE. C
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540
Mailing Address - Country:US
Mailing Address - Phone:609-921-6620
Mailing Address - Fax:609-921-6628
Practice Address - Street 1:211 N HARRISON ST
Practice Address - Street 2:STE. C
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3530
Practice Address - Country:US
Practice Address - Phone:609-921-6620
Practice Address - Fax:609-921-6628
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00485800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222532697OtherBLUE SHIELD
NJT49110Medicare UPIN
NJ222532697OtherBLUE SHIELD