MEDICARE: STEPHEN JOHN FULGIERI

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	156FX1800X	Optician	2536	FL

General Provider Information

NPI Number	:	1801984018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN JOHN FULGIERI

Provider Business Mailing Address
First Line	:	1269 S MISSOURI AVE
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-4174
Country	:	US
Telephone Number	:	727-461-4011
Fax Number	:	727-442-1392

Provider Business Practice Location Address
First Line	:	1269 S MISSOURI AVE
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-4174
Country	:	US
Telephone Number	:	727-461-4011
Fax Number	:	727-442-1392

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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