Healthcare Provider Details

I. General information

NPI: 1285581504
Provider Name (Legal Business Name): NATHAN ALEXANDER FULTON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MAIN ST STE 11
NORWALK CT
06851-3530
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 203-845-2020
  • Fax:
Mailing address:
  • Phone: 703-847-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3.003465
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: