DAVID A. FULLENKAMP,OD, PC (NPI# 1235457862) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235457862 |
| Entity Type | Organization |
| Organization Name | DAVID A. FULLENKAMP,OD, PC |
| Practice Address |
1111 N Meridian St Portland IN 47371-1024 |
| Mailing Address |
1111 N Meridian St P.o. Box 1268 Portland IN 47371-1024 |
| Practice Telephone | 2607264210 |
| Practice Fax Number | 2607269347 |
| Mailing Telephone | 2607264210 |
| Mailing Fax Number | 2607269347 |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2010-05-06 |
| Authorized Official Name | DR. DAVID A. FULLENKAMP (PRESIDENT) |
| Authorized Official Telephone | 2607264210 |
| Authorized Official Credential | OD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | 18002167A | IN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100424160A | 05 | |
| IN | PTAN | 0207200002 | 01 |
| Street Address |
1111 N MERIDIAN ST |
| City | PORTLAND |
| State | IN |
| Zip Code | 47371-1024 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861483612 | Eye Center Group, LLC | Ophthalmology | 1111 N Meridian St, Portland, IN 47371-1024 | 2005-11-01 |
| 1457975484 | Abby Elizabeth Small | Optometrist | 1111 N Meridian St, Portland, IN 47371-1024 | 2020-06-05 |
| 1346479284 | David A. Fullenkamp, O.d., P.C. | Eyewear Supplier (Equipment, not the service) | 1111 N Meridian St, Portland, IN 47371-1024 | 2009-07-14 |
| 1831108877 | The Eye Center Group LLC | Durable Medical Equipment & Medical Supplies | 1111 N Meridian St, Portland, IN 47371-1024 | 2006-08-07 |
| 1043297625 | David A Fullenkamp | Optometrist | 1111 N Meridian St, Portland, IN 47371-1024 | 2005-12-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093365355 | Susan Hathaway | Technician | 3783 West 800 South, Portland, IN 47371 | 2019-09-18 |
| 1336643410 | Lisa Marcella Moore | Nurse Practitioner | 500 W. Votaw Street, Portland, IN 47371 | 2018-03-22 |
| 1609186030 | Carolyn Louise Keihn | Nurse Practitioner | 430 W. Votaw St., Portland, IN 47371 | 2010-10-19 |
| 1922125384 | Carla Ann Ford | Social Worker | 1758 W 100s, Jay County Hopsital Behavioral Health, Portland, IN 47371 | 2007-03-23 |
| 1902824956 | Midwest Healthstrategies, Inc | Physical Therapist | 1745 W 100 S, Portland, IN 47371 | 2006-07-18 |
| 1346212875 | Jenni Clear | Chiropractor | 603 N Meridian St, Portland, IN 47371 | 2006-02-07 |
| 1497756043 | Jay County Government | Ambulance | 902 N Creagor Ave, Portland, IN 47371 | 2005-08-04 |
| 1336694736 | Anne Hardesty | Nurse Practitioner | 500 W Votaw St, Portland, IN 47371 | 2016-08-16 |
| 1861574006 | Wal-mart Stores East, Lp | Technician/Technologist | 950 W Votaw St, Portland, IN 47371 | 2006-10-19 |
| 1144296088 | Kent Farnsworth | Emergency Medicine | 500 W Votaw St, Portland, IN 47371 | 2006-02-28 |
| Find all providers in zip 47371 | ||||
| Taxonomy Code | 332H00000X |
| Grouping | Suppliers |
| Classification | Eyewear Supplier (Equipment, not the service) |
| An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518573914 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 513-515 Warren Avenue, Portland, ME 04103-1005 | 2020-09-21 |
| 1518473297 | Asterix Eyewear | Eyewear Supplier (Equipment, not the service) | 4936 Se Foster Rd, Portland, OR 97206-3037 | 2017-12-18 |
| 1831616929 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 817 Nw 23rd Ave, Portland, OR 97210-3003 | 2017-08-29 |
| 1568993988 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 9300 Sw Washington Square Rd, Portland, OR 97223-4428 | 2017-03-27 |
| 1063681617 | Oregon Eye Specialists PC | Eyewear Supplier (Equipment, not the service) | 5050 Ne Hoyt St Ste 445, Portland, OR 97213-2984 | 2008-02-28 |
| 1235337890 | Essilor Laboratories of America, Inc | Eyewear Supplier (Equipment, not the service) | 17311 Ne Halsey St, Portland, OR 97230-6025 | 2007-07-05 |
| 1225158496 | Anh Bui | Eyewear Supplier (Equipment, not the service) | 5845 Ne Prescott St, Portland, OR 97218-2231 | 2007-03-30 |
| 1023135670 | Robert M Barton Jr Od | Eyewear Supplier (Equipment, not the service) | 1540 Wildcat Dr, Ste A, Portland, TX 78374-2814 | 2007-03-26 |
| 1831243278 | Usv Optical Inc. | Eyewear Supplier (Equipment, not the service) | 513-515 Warren Ave, Portland, ME 04103 | 2007-01-23 |
| 1114076809 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 1260 Lloyd Ctr, Portland, OR 97232-1301 | 2007-01-10 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.