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General NPI Number Information
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NPI Number | 1043578875
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Entity Type | Organization
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Legal Business Name | SHELIA A. FULLER, O.D., L.L.C
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 339 N LEXINGTON SPRINGMILL RD
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City | ONTARIO
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State | OH
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Zip | 44906-1218
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Country | US
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Telephone | 419-525-2060
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Fax | 419-529-9060
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Provider Business Mailing Address
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Address Line | 339 N LEXINGTON SPRINGMILL RD
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City | ONTARIO
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State | OH
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Zip | 44906-1218
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Country | US
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Telephone | 419-525-2060
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Fax | 419-529-9060
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHELIA FULLER
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Credential |
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Telephone | 419-525-2060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901-T1771
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License Number State | OH
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