Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1366076556 |
---|---|
Provider Name | Edwin Peter Bullard |
First Address | Tulsa, OK 74146-5218 |
Second Address | Tulsa, OK 74146-5218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2020 |
Last Update Date | 26/02/2020 |