Individual
JOHN ROBERT FULTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1631 E EMPIRE ST, BLOOMINGTON, IL 61701-3531
(309) 662-4074
(309) 662-4074
Mailing address
114 E WILLIAMS ST, BROADWELL, IL 62634-6367
(217) 732-7422
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
46-006841
IL
Other
Enumeration date
12/19/2006
Last updated
07/08/2007
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