Provider Demographics
NPI:1386607000
Name:TULLER, ROY E (DO)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:E
Last Name:TULLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 N ACADEMY AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4093
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:255 ROUTE 220 HWY STE 203
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-7569
Practice Address - Country:US
Practice Address - Phone:570-321-0880
Practice Address - Fax:570-321-8012
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009835L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007386239OtherAETNA
PA2153242OtherUNITED HEALTHCARE
PA816741OtherFIRST PRIORITY HEALTH
PA001938093Medicaid
PA0019380930003OtherMEDICAID MUNCY
PA321821OtherUPMC
PA76917-5365OtherGEISINGER HEALTH PLAN
PA036635OtherAMERIHEALTH
PA180046237OtherRAILROAD MEDICARE
PA385321OtherHEALTH AMERICA
PA0019380930007OtherMEDICAID LEWISBURG
PA059444767OtherTRICARE/CHAMPUS
PA436635OtherBCBS
PA0019380930002OtherMEDICAID DUBOIS
PA50010412OtherCAPITAL BC
PA0019380930005OtherMEDICAID WILLIAMSPORT
PA0007386239OtherAETNA
PA816741OtherFIRST PRIORITY HEALTH