Individual
DR. ROBERT ALLEN FULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
402 W CHICKASHA AVE, CHICKASHA, OK 73018-2504
(405) 224-3937
(405) 224-4375
Mailing address
402 W CHICKASHA AVE, CHICKASHA, OK 73018-2504
(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
—
20-5009490
FEDERAL TAX ID
—
01
—
OKAAA2511
MEDICARE INDIVIDUAL PTAN
OK
01
—
OKAAA2512
MEDICARE GROUP PTAN
OK
Enumeration date
08/15/2008
Last updated
12/16/2014
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