Organization
PAUL FULGHUM OD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL FULGHUM OPTOMETRIST (OWNER)
(904) 387-5704
Entity
Organization
Contact information
Practice address
4225 LAKESIDE DR, JACKSONVILLE, FL 32210-3305
(904) 387-5704
Mailing address
4225 LAKESIDE DR, JACKSONVILLE, FL 32210-3305
(904) 387-5704
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC1834
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
086592300
—
FL
Enumeration date
10/15/2008
Last updated
11/03/2010
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