Individual
PAUL FULGHUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD PA
Contact information
Practice address
4225 LAKESIDE DR, JACKSONVILLE, FL 32210-3305
(904) 387-5704
(904) 387-5751
Mailing address
4225 LAKESIDE DR, JACKSONVILLE, FL 32210-3305
(904) 387-5704
(904) 387-5751
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1834
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
086952300
—
FL
Enumeration date
07/11/2006
Last updated
11/29/2023
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