Healthcare Provider Details

I. General information

NPI: 1144979311
Provider Name (Legal Business Name): ALYSON NICOLE TUKAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WESTHAMPTON STA
RICHMOND VA
23226-3330
US

IV. Provider business mailing address

994 W 2ND ST UNIT 294
WINSTON SALEM NC
27101-3881
US

V. Phone/Fax

Practice location:
  • Phone: 804-278-2020
  • Fax: 804-379-0985
Mailing address:
  • Phone: 480-620-7077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101288706
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: