IndividualActive
Crystal Fuller, LDO, ABOC, NCLEC
NPI 1912725060 · Optician · Ellenwood, GA
Provider details
- NPI number
- 1912725060
- Entity type
- Individual
- Primary specialty
- OpticianEye and Vision Services Providers
- Credential
- LDO, ABOC, NCLEC
- Sex
- Female
- Sole proprietor
- Yes
- License
- 2429 (GA)
Specialties & taxonomies
Eye and Vision Services Providers
Practice location
3068 Cotton Indian Cir
Ellenwood, GA 30294-3587
Phone: (404) 824-8261
Fax: (770) 719-4392
Approximate (ZIP-level) locationGet directions
Mailing address
3068 Cotton Indian Cir
Ellenwood, GA 30294-3587
Registry dates
- Enumerated
- 2024-09-27
- Last updated
- 2024-09-27
- Certified
- 2024-09-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.