Individual
MICHAEL J FULLERTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
202 S ADAIR ST, PRYOR, OK 74361-5202
(918) 825-0055
(918) 824-2000
Mailing address
PO BOX 1400, PRYOR, OK 74362-1400
(918) 825-0055
(918) 824-2000
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
877
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100764830A
—
OK
Enumeration date
02/16/2007
Last updated
03/25/2009
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