Dr. B.D. Fuller & Assoc

Primary specialty

OptometristTaxonomy code 152W00000X

License

6991TG Issued in TX

Legal business name

DR. B.D. FULLER & ASSOC

Practice address

11200 Lakeline Mall Dr Lowr Level
Ste E-5
Cedar Park, TX 78613-1501

Phone

(512) 401-6000

Fax

(512) 401-6004

NPI assigned

Oct 10, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Bridgette Fuller, O.D.

Title

Optometrist

Phone

(512) 636-1995

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284681600000",
    "number": "1669560579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3602 LUMINOSO LN W",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786812395",
            "telephone_number": "512-636-1995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11200 LAKELINE MALL DR LOWR LEVEL",
            "address_2": "STE E-5",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786131501",
            "telephone_number": "512-401-6000",
            "fax_number": "512-401-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. B.D. FULLER & ASSOC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2010-09-17",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "BRIDGETTE",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "512-636-1995",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "6991TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI ENUMERATOR",
            "identifier": "1528025582",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2010; 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.