Orazio F Santullo, O.D.
Individual provider Active NPI Optometrist · Andrews Afb, MD
NPI 1497956924 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1497956924
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- TA1385 (MD)
- Practice address
- 1050 W Perimeter Rd
Andrews Afb, MD 20762-6601 - Phone
- (301) 619-8627
- NPI assigned
- May 31, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TA1385 | MD | MD | Optometrist |
| 27TO00098800 | NJ | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TA1385 | MD | Yes |
| Optometrist | 152W00000X | 27TO00098800 | NJ |
Addresses
Primary practice location
1050 W Perimeter Rd
Andrews Afb, MD 20762-6601
Mailing address
1270 Montevue LN
Fort Detrick, MD 21702-5058
Phone (301) 619-8627
Other providers in Andrews Afb, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.