Ryan Tyler Fullen, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1659 Issued in SC

Practice address

1774 Paxville Hwy
Manning, SC 29102-5071

Phone

(803) 435-2494

Fax

(803) 435-8765

NPI assigned

Jul 11, 2011

Last updated

Mar 3, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clarendon Eye Center P a

  • Optometrist
  • Manning, SC
  • NPI 1174619423
  NPD (past)

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

{
    "created_epoch": "1310342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425340800000",
    "number": "1245528389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8096 RIVERS AVE",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069235",
            "telephone_number": "843-818-2020",
            "fax_number": "843-818-2379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1774 PAXVILLE HWY",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291025071",
            "telephone_number": "803-435-2494",
            "fax_number": "803-435-8765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLEN",
        "first_name": "RYAN",
        "middle_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-11",
        "last_updated": "2015-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Faith Therapeutic Services
• Ashlee Finnell, OD
• Jordan Carter Floyd
• Judy Lynn Fry, CNM
• Marissa Fullard
• Gamble Dentalsmart PC (DentalSmart)
• Tracy Ganes, CRNA
• Reynald Bassig Garma, MD
• Marion Claire Geddings, FNP-BC
• Katrina Gibson, RN

• Optometrist in Manning, SC
• Providers in Manning, SC by specialty
• Optometrist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.