Provider Demographics
NPI:1043578875
Name:SHELIA A. FULLER, O.D., L.L.C
Entity Type:Organization
Organization Name:SHELIA A. FULLER, O.D., L.L.C
Other - Org Name:SHELIA FULLER OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-525-2060
Mailing Address - Street 1:339 N LEXINGTON SPRINGMILL RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1218
Mailing Address - Country:US
Mailing Address - Phone:419-525-2060
Mailing Address - Fax:419-529-9060
Practice Address - Street 1:339 N LEXINGTON SPRINGMILL RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-1218
Practice Address - Country:US
Practice Address - Phone:419-525-2060
Practice Address - Fax:419-529-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4901-T1771152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty