Fuller Optical, LLC

Primary specialty

Point of ServiceTaxonomy code 305S00000X

License

S320TA285 Issued in AL

Legal business name

FULLER OPTICAL, LLC

Practice address

210 2ND Ave SE
Cullman, AL 35055-3514

Phone

(256) 734-1121

Fax

(256) 734-1991

NPI assigned

Apr 3, 2012

Last updated

Apr 3, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Wayne B Fuller, O.D.NPI 1689761041

Title

Owner

Phone

(256) 734-1121

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Wayne B Fuller, O.D.

  • Optometrist
  • Cullman, AL
  • NPI 1689761041
  NPD (past) Authorized official

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

{
    "created_epoch": "1333411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333411200000",
    "number": "1093071193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 2ND AVE SE",
            "city": "CULLMAN",
            "state": "AL",
            "postal_code": "350553514",
            "telephone_number": "256-734-1121",
            "fax_number": "256-734-1991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 2ND AVE SE",
            "city": "CULLMAN",
            "state": "AL",
            "postal_code": "350553514",
            "telephone_number": "256-734-1121",
            "fax_number": "256-734-1991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLER OPTICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-03",
        "last_updated": "2012-04-03",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "256-734-1121",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "AL",
            "license": "S320TA285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "051554145",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rita Kay Freeman, RPHARMACIST
• Tammie Michelle Friedrichs, L.M.T.
• Hayden Friesen
• Cassandra W Frieson, DNP, CRNP
• Fuller Optical
• Steven B Fuller, D.O.
• Wayne B Fuller, O.D.
• Jamie Gandy
• Leah Varden Gann, CRNP
• Denise Elaine Gardner, CRNP

• Point of Service in Cullman, AL
• Providers in Cullman, AL by specialty
• Point of Service in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2012; 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.