Organization
DR. B.D. FULLER & ASSOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIDGETTE FULLER O.D. (OPTOMETRIST)
(512) 636-1995
Entity
Organization
Contact information
Practice address
11200 LAKELINE MALL DR LOWR LEVEL, STE E-5, CEDAR PARK, TX 78613-1501
(512) 401-6000
(512) 401-6004
Mailing address
3602 LUMINOSO LN W, ROUND ROCK, TX 78681-2395
(512) 636-1995
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6991TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1528025582
NPI ENUMERATOR
TX
Enumeration date
10/10/2006
Last updated
09/17/2010
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