Individual
DR. DANIEL GUNN FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1225 MADISON AVE, MEMPHIS, TN 38104-2211
(901) 722-3319
(901) 722-3394
Mailing address
1225 MADISON AVE, MEMPHIS, TN 38104-2211
(901) 722-3319
(901) 722-3394
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T1170
TN
152WC0802X
Corneal and Contact Management Optometrist
T1170
TN
152WL0500X
Low Vision Rehabilitation Optometrist
T1170
TN
152WP0200X
Pediatric Optometrist
T1170
TN
152WS0006X
Sports Vision Optometrist
T1170
TN
152WV0400X
Vision Therapy Optometrist
T1170
TN
152WX0102X
Occupational Vision Optometrist
T1170
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001916913
BC BS OF TN
TN
Enumeration date
03/16/2006
Last updated
07/12/2010
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