Individual
DR. RYAN TYLER FULLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1774 PAXVILLE HWY, MANNING, SC 29102-5071
(803) 435-2494
(803) 435-8765
Mailing address
8096 RIVERS AVE, NORTH CHARLESTON, SC 29406-9235
(843) 818-2020
(843) 818-2379
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1659
SC
Other
Enumeration date
07/11/2011
Last updated
03/03/2015
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