Organization
TWIN FORKS OPTOMETRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSICA FULMER O.D. (OWNER)
(315) 439-7518
Entity
Organization
Contact information
Practice address
25 CRANBERRY STREET, RIVERHEAD, NY 11901
(631) 740-9384
(631) 740-9385
Mailing address
25 CRANBERRY STREET, RIVERHEAD, NY 11901-5611
(631) 740-9384
(631) 740-9385
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
007991
NY
152WC0802X
Corneal and Contact Management Optometrist
007991
NY
152WP0200X
Pediatric Optometrist
007991
NY
152WV0400X
Vision Therapy Optometrist
007991
NY
Other
Enumeration date
06/05/2015
Last updated
09/16/2015
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