Individual
DR. MICHAEL D. FULFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
304 LAURENS ST NW, AIKEN, SC 29801-3997
(803) 649-9561
(803) 649-2664
Mailing address
304 LAURENS ST NW, AIKEN, SC 29801-3997
(803) 649-9561
(803) 649-2664
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0517
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0596560001
DMERC NUMBER
SC
01
—
410044189
RR MEDICARE
SC
05
—
DA9643
—
SC
Enumeration date
07/18/2006
Last updated
04/24/2012
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