Provider Demographics
NPI:1063562353
Name:DANIEL TULMAN OD PC
Entity type:Organization
Organization Name:DANIEL TULMAN OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTORPRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:TULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-948-0036
Mailing Address - Street 1:880 CRESTMARK DR
Mailing Address - Street 2:STE 101
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-2646
Mailing Address - Country:US
Mailing Address - Phone:770-948-0036
Mailing Address - Fax:770-948-0090
Practice Address - Street 1:880 CRESTMARK DR
Practice Address - Street 2:STE 101
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-2646
Practice Address - Country:US
Practice Address - Phone:770-948-0036
Practice Address - Fax:770-948-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA814152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00153645AMedicaid
GA00153645AMedicaid
GAU21170Medicare UPIN
GAGRP4523Medicare PIN
GADB7165Medicare PIN