Provider Demographics
NPI:1720072283
Name:HULLMAN, GEOFFREY DAVID (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:DAVID
Last Name:HULLMAN
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 ARTHUR GODFREY RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3510
Mailing Address - Country:US
Mailing Address - Phone:305-534-2288
Mailing Address - Fax:305-534-9214
Practice Address - Street 1:552 ARTHUR GODFREY RD
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3510
Practice Address - Country:US
Practice Address - Phone:305-534-2288
Practice Address - Fax:305-534-9214
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO504156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0800150001Medicare ID - Type UnspecifiedOPTICIAN