# PAUL FULGHUM OD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861644379
- **Authorized official:** PAUL FULGHUM OPTOMETRIST (OWNER)
- **Authorized official phone:** (904) 387-5704

## Contact information

- **Practice address:** 4225 LAKESIDE DR, JACKSONVILLE, FL 32210-3305
- **Practice address phone:** (904) 387-5704
- **Mailing address:** 4225 LAKESIDE DR, JACKSONVILLE, FL 32210-3305
- **Mailing address phone:** (904) 387-5704

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OPC1834 | FL | Yes |

## Other

- **Enumeration date:** 10/15/2008
- **Last updated:** 11/03/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 086592300 | — | FL |