Individual
DR. LAWRENCE P FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
703 N MAIN ST, KISSIMMEE, FL 34744-5265
(407) 846-2020
(407) 846-8039
Mailing address
703 N MAIN ST, KISSIMMEE, FL 34744-5265
(407) 846-2020
(407) 846-8039
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC00797
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
596166473
TAX ID
FL
Enumeration date
08/24/2005
Last updated
02/26/2008
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