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Individual
DR. LAWRENCE P FULLER
Active
Individual
DR. LAWRENCE P FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC00797
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
596166473
TAX ID
FL
Enumeration date
08/24/2005
Last updated
02/26/2008
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