Provider Demographics
NPI:1104984145
Name:ALAM, TULEEN (OD)
Entity type:Individual
Prefix:
First Name:TULEEN
Middle Name:
Last Name:ALAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11103 WEST AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1370
Mailing Address - Country:US
Mailing Address - Phone:210-524-6509
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:6250 COLUMBIA CROSSING DR
Practice Address - Street 2:SUITE K
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-8010
Practice Address - Country:US
Practice Address - Phone:443-285-0100
Practice Address - Fax:443-285-0110
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1275152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU99620Medicare UPIN
MD501MI517Medicare ID - Type UnspecifiedMEDICARE