Healthcare Provider Details

I. General information

NPI: 1417193889
Provider Name (Legal Business Name): WILLIAM J. TULLO, OD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N HARRISON ST STE 9B
PRINCETON NJ
08540-3512
US

IV. Provider business mailing address

301 N HARRISON ST STE 9B
PRINCETON NJ
08540-3512
US

V. Phone/Fax

Practice location:
  • Phone: 609-921-6620
  • Fax:
Mailing address:
  • Phone: 609-921-6620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number27OA00485801
License Number StateNJ

VIII. Authorized Official

Name: DR. WILLIAM J. TULLO
Title or Position: OWNER
Credential: O.D.
Phone: 609-921-6620