Provider Demographics
NPI:1114013042
Name:DARLA J FULLER
Entity Type:Organization
Organization Name:DARLA J FULLER
Other - Org Name:EYE CARE FOR YOU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-329-3937
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:329 N. MAIN ST.
Mailing Address - City:RENVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56284-0430
Mailing Address - Country:US
Mailing Address - Phone:320-329-3937
Mailing Address - Fax:320-329-3894
Practice Address - Street 1:329 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RENVILLE
Practice Address - State:MN
Practice Address - Zip Code:56284-0430
Practice Address - Country:US
Practice Address - Phone:320-329-3937
Practice Address - Fax:320-329-3894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN109589OtherUCARE
MN3C783EYOtherBLUE CROSS BLUE SHIELD MN
MN1023273OtherPREFERRED ONE
MN103342OtherHEALTH PARTNERS
MN2211871OtherMEDICA
MN103342OtherHEALTH PARTNERS