Paul Fulghum OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC1834 Issued in FL

Legal business name

PAUL FULGHUM OD PA

Practice address

4225 Lakeside Dr
Jacksonville, FL 32210-3305

Phone

(904) 387-5704

NPI assigned

Oct 15, 2008

Organization subpart

No

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

Authorized official

Name

Paul Fulghum, OPTOMETRIST

Title

Owner

Phone

(904) 387-5704

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1224028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288742400000",
    "number": "1861644379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4225 LAKESIDE DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322103305",
            "telephone_number": "904-387-5704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4225 LAKESIDE DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322103305",
            "telephone_number": "904-387-5704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL FULGHUM OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-15",
        "last_updated": "2010-11-03",
        "status": "A",
        "authorized_official_last_name": "FULGHUM",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-387-5704",
        "authorized_official_credential": "OPTOMETRIST"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC1834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "086592300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Paul V Jones, Inc.
• Paul Vision Care LLC

• Optometrist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Optometrist in Florida

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