MEDICARE: DR. TAMMY T TULLY O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1061	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043261084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMMY T TULLY O.D.

Provider Business Mailing Address
First Line	:	PO BOX 50997
Second Line	:	4606 MOONBEAM CT
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-0017
Country	:	US
Telephone Number	:	843-520-0576
Fax Number	:	843-520-4398

Provider Business Practice Location Address
First Line	:	109 FINNEGAN CT
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4205
Country	:	US
Telephone Number	:	843-903-0949
Fax Number	:	843-903-1101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	08/01/2008

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