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General NPI Number Information
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NPI Number | 1881859734
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Entity Type | Individual
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Provider Name | MICHAEL ANTHONY TOMMOLINO O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 08/25/2026
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Provider Practice Location Address
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Address Line | 48 MDG / RAF LAKENHEATH UNIT 5115
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City | APO
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State | AE
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Zip | 09461
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Country | US
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Telephone | 314-226-8205
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Fax |
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Provider Business Mailing Address
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Address Line | 7321 BALMER ST BLDG 570
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City | HILL AFB
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State | UT
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Zip | 84056-5012
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901004489
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License Number State | MI
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