Healthcare Provider Details

I. General information

NPI: 1073752176
Provider Name (Legal Business Name): DONALD S FULTON OD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 MONROE TPKE SUITE 200
MONROE CT
06468-2338
US

IV. Provider business mailing address

471 MONROE TPKE SUITE 200
MONROE CT
06468-2338
US

V. Phone/Fax

Practice location:
  • Phone: 203-261-5783
  • Fax: 203-268-7036
Mailing address:
  • Phone: 203-261-5783
  • Fax: 203-268-7036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number765
License Number StateCT

VIII. Authorized Official

Name: DR. DONALD S FULTON
Title or Position: OWNER/PROVIDER
Credential: OD
Phone: 203-261-5783