MEDICARE: VYTAUTAS TAMULIS

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	156FX1800X	Optician

General Provider Information

NPI Number	:	1336565985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VYTAUTAS TAMULIS

Provider Business Mailing Address
First Line	:	PO BOX 587514
Second Line	:
City	:	ALSIP
State	:	IL
Zip	:	60803-7514
Country	:	US
Telephone Number	:	815-483-9504
Fax Number	:

Provider Business Practice Location Address
First Line	:	3457 W 111TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-3335
Country	:	US
Telephone Number	:	815-483-9504
Fax Number	:

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

Provider Enumeration Date	:	03/06/2014
Last Update Date	:	03/06/2014

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Directions to “ VYTAUTAS TAMULIS ” Practice Location

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