Organization
FULLER OPTICAL, LLC
Active
Organization
FULLER OPTICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WAYNE B FULLER O.D. (OWNER)
(256) 734-1121
Entity
Organization
Contact information
Practice address
210 2ND AVE SE, CULLMAN, AL 35055-3514
(256) 734-1121
(256) 734-1991
Mailing address
210 2ND AVE SE, CULLMAN, AL 35055-3514
(256) 734-1121
(256) 734-1991
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
S320TA285
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051554145
MEDICARE PTAN
AL
Enumeration date
04/03/2012
Last updated
04/03/2012
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