Provider Demographics
NPI:1801984018
Name:FULGIERI, STEPHEN JOHN
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOHN
Last Name:FULGIERI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1269 S MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4174
Mailing Address - Country:US
Mailing Address - Phone:727-461-4011
Mailing Address - Fax:727-442-1392
Practice Address - Street 1:1269 S MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4174
Practice Address - Country:US
Practice Address - Phone:727-461-4011
Practice Address - Fax:727-442-1392
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2536156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician