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General NPI Number Information
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NPI Number | 1154508109
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Entity Type | Organization
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Legal Business Name | THOMAS S. GULLOTTI,O.D.
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 560 W 3RD ST
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City | JAMESTOWN
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State | NY
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Zip | 14701-4776
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Country | US
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Telephone | 716-484-0325
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Fax | 716-484-0343
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Provider Business Mailing Address
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Address Line | 560 W 3RD ST
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City | JAMESTOWN
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State | NY
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Zip | 14701-4776
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Country | US
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Telephone | 716-484-0325
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Fax | 716-484-0343
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS S. GULLOTTI
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Credential | O.D.
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Telephone | 716-484-0325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | TUV3647
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License Number State | NY
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