David A. Fullenkamp,od, PC

NPI #1235457862 in Portland, Indiana

Provider Information

NPI Number: 1235457862
Entity Type: Organization
Organization Name: David A. Fullenkamp,od, PC
Primary Specialty: Eyewear Supplier
Enumeration Date: May 6, 2010
Last Updated: May 6, 2010

Practice Location

Address: 1111 N MERIDIAN ST
City: Portland
State: Indiana
ZIP Code: 47371-1024
Phone: (260) 726-4210

Authorized Official

Name: DR. DAVID A. FULLENKAMP, OD
Title: PRESIDENT
Phone: (260) 726-4210

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Eyewear Supplier	332H00000X	Primary

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