Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
CRYSTAL MARY AGATHA FULLER, LDO, ABOC, NCLEC
Active Sole ProprietorCRYSTAL MARY AGATHA FULLER, LDO, ABOC, NCLEC is a Optician, Dispensing healthcare provider located in ELLENWOOD, Georgia. NPI 1912725060 is currently active in the NPPES registry. Verify at CMS.
Optician, Dispensing · ELLENWOOD, GA
Registration Details
- NPI Number
- 1912725060
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Sep 27, 2024 (1.9092304908883 yrs)
- Last Updated
- Sep 27, 2024
- License
-
2429 (GA)
- Sole Proprietor
- Yes
Practice Information
- Address
-
3068 COTTON INDIAN CIRELLENWOOD, GA, 302943587Browse GA providers · Browse ZIP 30294
- Phone
- 4048248261
- Fax
- 7707194392
- Primary Specialty
-
Optician, Dispensing
156FX1800X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.