Individual
TERI FULLMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ABO
Contact information
Practice address
7447 W EMERALD ST STE 105, BOISE, ID 83704-5003
(208) 322-1642
(208) 378-4179
Mailing address
7447 W EMERALD ST STE 105, BOISE, ID 83704-5003
(208) 322-1642
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
065186
ABO
—
Enumeration date
07/26/2018
Last updated
07/26/2018
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