MEDICARE: CATHY A FULP O.D.

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	152W00000X	Optometrist	1388	NC
2	152WP0200X	Pediatric Optometrist	1388	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0929A	OTHER	NC	BCBSNC

General Provider Information

NPI Number	:	1902803323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHY A FULP O.D.

Provider Business Mailing Address
First Line	:	PO BOX 4370
Second Line	:
City	:	ARCHDALE
State	:	NC
Zip	:	27263-4370
Country	:	US
Telephone Number	:	336-434-4033
Fax Number	:	336-434-6680

Provider Business Practice Location Address
First Line	:	10564 N MAIN ST
Second Line	:	STE E
City	:	ARCHDALE
State	:	NC
Zip	:	27263-2472
Country	:	US
Telephone Number	:	336-434-4033
Fax Number	:	336-434-4035

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	10/13/2010

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Directions to “ CATHY A FULP O.D.” Practice Location

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