| David A. Fullenkamp, O.d., P.c. | |
|
1111 N Meridian St, Portland, IN 47371-1024 | |
| (260) 726-5161 | |
| Not Available |
| Full Name | David A. Fullenkamp, O.d., P.c. |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 1111 N Meridian St, Portland, Indiana |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346479284 | NPI | - | NPPES |
| 100424160A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | 18002167A (Indiana) | Primary |
| 332H00000X | Eyewear Supplier | 18002167A (Indiana) | Secondary |
| Provider Name | David Allen Fullenkamp |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1043297625 PECOS PAC ID: 2466355433 Enrollment ID: I20060330000674 |
| Provider Name | Abby E Small |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1457975484 PECOS PAC ID: 1254753569 Enrollment ID: I20200615001809 |
| Mailing Address | Practice Location Address |
|---|---|
| David A. Fullenkamp, O.d., P.c. 1111 N Meridian St, P.o. Box 1268, Portland, IN 47371-1024 Ph: (260) 726-5161 | David A. Fullenkamp, O.d., P.c. 1111 N Meridian St, Portland, IN 47371-1024 Ph: (260) 726-5161 |
David A Fullenkamp, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 1111 N Meridian St, Portland, IN 47371 Phone: 260-726-4210 Fax: 260-726-9347 | |
Dr. Abby Elizabeth Small, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 1111 N Meridian St, Portland, IN 47371 Phone: 260-726-4210 Fax: 260-726-9347 | |
Portland Eye Center Optometrist Medicare: Not Enrolled in Medicare Practice Location: 1111 N Meridian St, Portland, IN 47371 Phone: 260-726-4210 Fax: 260-726-9347 |