Robert Dillon Fullenwider, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046011435 Issued in IL

Practice address

823 9TH St
Highland, IL 62249-1521

Phone

(618) 654-9848

NPI assigned

Aug 12, 2020

Last updated

Aug 12, 2020By the provider in NPPES

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

Enrolled in MO, IL2 enrollments

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 2

Specialty

Optometry

Education

Ohio State University - College of Optometry, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Nucrown, LLCGroup PAC ID 1456256346, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Nu-Crown, LLC

  dba Crown Optical

  • Optometrist
  • Alton, IL
  • NPI 1295737294

  MO

  Medicare reassignment Care Compare group NPD
• Christina J. Levi O D P C

  dba Edwardsville Vision Center

  • Optometrist
  • Edwardsville, IL
  • NPI 1477703411
  Medicare reassignment NPD
• Rosenthal Optometric Association LTD

  • Optometrist
  • Highland, IL
  • NPI 1386670099
  NPD
• Nucrown,Inc.

  dba Crown Optical

  • Optometrist
  • Saint Charles, MO
  • NPI 1114337102
  NPD
• Christina J. Levi O D P C

  dba Edwardsville Vision Center

  • Optometrist
  • Edwardsville, IL
  • NPI 1033261904
  NPD (past)
• JFJ Eyecare LTD

  dba Quantum Vision Centers

  • Optometrist
  • Swansea, IL
  • NPI 1295778587
  NPD (past)

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

{
    "created_epoch": "1597190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597190400000",
    "number": "1699386755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1412 DORIS AVE",
            "city": "CAHOKIA",
            "state": "IL",
            "postal_code": "622062234",
            "telephone_number": "618-980-3840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "823 9TH ST",
            "city": "HIGHLAND",
            "state": "IL",
            "postal_code": "622491521",
            "telephone_number": "618-654-9848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLENWIDER",
        "first_name": "ROBERT",
        "middle_name": "DILLON",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-12",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046011435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carli Rae Fields
• Christina M Frank, PT, MBA
• Kane M Freeman, PT
• Holley Anne Friesz Heidel, SLP-L
• Vonda Fugate
• Roger L Fulton, MD
• Sherri Denise Gaffner
• Brent Michael Garner
• Hannah Gaumer
• Jay Leonard Geiger

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.