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General NPI Number Information
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NPI Number | 1427297225
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Entity Type | Organization
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Legal Business Name | DONALD S FULTON OD
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 11/04/2010
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Provider Practice Location Address
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Address Line | 131 MAIN ST THOMASTON SQUARE, SUITE 4
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City | THOMASTON
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State | CT
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Zip | 06787-1747
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Country | US
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Telephone | 860-283-9857
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Fax | 860-283-5414
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Provider Business Mailing Address
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Address Line | 131 MAIN ST THOMASTON SQUARE, SUITE 4
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City | THOMASTON
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State | CT
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Zip | 06787-1747
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Country | US
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Telephone | 860-283-9857
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Fax | 860-283-5414
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. DONALD S FULTON
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Credential | OD
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Telephone | 860-283-9857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 765
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License Number State | CT
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