John Robert Fults, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

46-006841 Issued in IL

Practice address

1631 E Empire St
Bloomington, IL 61701-3531

Phone

(309) 662-4074

Fax

(309) 662-4074

NPI assigned

Dec 19, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083777890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 E WILLIAMS ST",
            "city": "BROADWELL",
            "state": "IL",
            "postal_code": "626346367",
            "telephone_number": "217-732-7422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1631 E EMPIRE ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013531",
            "telephone_number": "309-662-4074",
            "fax_number": "309-662-4074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULTS",
        "first_name": "JOHN",
        "middle_name": "ROBERT",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "46-006841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.