Provider Demographics
NPI:1801183660
Name:FULTON, KARINA (OD)
Entity Type:Individual
Prefix:DR
First Name:KARINA
Middle Name:
Last Name:FULTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 W 103RD ST STE 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2900
Mailing Address - Country:US
Mailing Address - Phone:574-213-2003
Mailing Address - Fax:
Practice Address - Street 1:1439 W 103RD ST STE 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2900
Practice Address - Country:US
Practice Address - Phone:773-647-2709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010459152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist