Organization
DAVID A. FULLENKAMP,OD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID A. FULLENKAMP OD (PRESIDENT)
(260) 726-4210
Entity
Organization
Contact information
Practice address
1111 N MERIDIAN ST, PORTLAND, IN 47371-1024
(260) 726-4210
(260) 726-9347
Mailing address
1111 N MERIDIAN ST, P.O. BOX 1268, PORTLAND, IN 47371-1024
(260) 726-4210
(260) 726-9347
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
18002167A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0207200002
PTAN
IN
05
—
100424160A
—
IN
Enumeration date
05/06/2010
Last updated
05/06/2010
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up