Provider Demographics
NPI:1972224814
Name:FULTON, STEPHANIE CHRISTINE (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:CHRISTINE
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 1:1511 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-2219
Mailing Address - Country:US
Mailing Address - Phone:918-857-2750
Mailing Address - Fax:
Practice Address - Street 1:1704 N 9TH ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8283
Practice Address - Country:US
Practice Address - Phone:918-355-7450
Practice Address - Fax:918-355-7456
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3170152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist