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Individual

THOMAS FULLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
2B HAW CREEK LN, ASHEVILLE, NC 28805-2250
(828) 298-0854
(828) 298-2738
Mailing address
2B HAW CREEK LN, ASHEVILLE, NC 28805-2250
(828) 298-0854
(828) 298-2738

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1477
NC
152WC0802X
Corneal and Contact Management Optometrist
1477
NC
152WL0500X
Low Vision Rehabilitation Optometrist
1477
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0907H
BLUE CROSS BLUE SHIELD
NC
01
22-71413
UNITED HEALTHCARE
NC
05
890907H
NC
Enumeration date
05/05/2006
Last updated
11/22/2011
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