Individual
DR. ROBERT DILLON FULLENWIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
823 9TH ST, HIGHLAND, IL 62249-1521
(618) 654-9848
Mailing address
1412 DORIS AVE, CAHOKIA, IL 62206-2234
(618) 980-3840
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046011435
IL
Other
Enumeration date
08/12/2020
Last updated
08/12/2020
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