MEDICARE: DONALD S FULTON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	765	CT

General Provider Information

NPI Number	:	1073752176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD S FULTON OD

Provider Business Mailing Address
First Line	:	471 MONROE TPKE
Second Line	:	SUITE 200
City	:	MONROE
State	:	CT
Zip	:	06468-2338
Country	:	US
Telephone Number	:	203-261-5783
Fax Number	:	203-268-7036

Provider Business Practice Location Address
First Line	:	471 MONROE TPKE
Second Line	:	SUITE 200
City	:	MONROE
State	:	CT
Zip	:	06468-2338
Country	:	US
Telephone Number	:	203-261-5783
Fax Number	:	203-268-7036

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	DR. DONALD S FULTON
Credential	:	OD
Telephone Number	:	203-261-5783

Provider Enumeration Date	:	02/12/2009
Last Update Date	:	11/04/2010

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