Organization
FULTON EYECARE CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT ALLEN FULTON O.D. (PRESIDENT)
(405) 224-3937
Entity
Organization
Contact information
Practice address
402 W CHICKASHA AVE STE 100, CHICKASHA, OK 73018-2461
(405) 224-3937
(405) 224-4375
Mailing address
402 W CHICKASHA AVE STE 100, CHICKASHA, OK 73018-2461
(405) 224-3937
(405) 224-4375
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2559
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851547301
PERSONAL NPI #
OK
01
—
OKAAA2511
MEDICARE INDIVIDUAL PTAN
OK
01
—
OKAAA2512
MEDICARE GROUP PTAN
OK
Enumeration date
07/25/2006
Last updated
06/28/2012
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