Organization
MICHAEL D. FULFORD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL DENNIS FULFORD OD (PRESIDENT)
(803) 649-9561
Entity
Organization
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
517
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DA9643
—
SC
01
—
DS1538
RAILROAD MEDICARE
SC
01
—
T250179184
MEDICARE PTAN
SC
Enumeration date
12/05/2006
Last updated
05/04/2012
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