Crystal Mary Agatha Fuller, LDO, ABOC, NCLEC

Optician · Ellenwood, GA

Individual Active NPI

NPI number 1912725060

Practice location

3068 Cotton Indian Cir
Ellenwood, GA 30294-3587

Phone: (404) 824-8261
Fax: (770) 719-4392

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NPI record

NPI: 1912725060
Entity type: Individual (Type 1)
Enumeration date: September 27, 2024
Last updated: September 27, 2024
Certified: September 27, 2024
Sole proprietor: Yes

Specialties & taxonomy codes

Taxonomy	Code	License	State
Optician Primary	`156FX1800X`	2429	GA

About Crystal Fuller

Crystal Mary Agatha Fuller, LDO, ABOC, NCLEC is a healthcare provider registered in the NPI registry with the primary taxonomy Optician (code 156FX1800X). The practice location is 3068 Cotton Indian Cir, Ellenwood, GA 30294-3587. The NPI number 1912725060 was assigned on September 27, 2024 and the record was last updated on September 27, 2024.

Crystal Fuller lists a license in the registry: #2429 (GA) for Optician. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Crystal Mary Agatha Fuller, LDO, ABOC, NCLEC?

The NPI number is 1912725060.

What is the phone number of Crystal Fuller?

The phone number listed for the practice location is (404) 824-8261.

Where is Crystal Fuller located?

3068 Cotton Indian Cir, Ellenwood, GA 30294-3587.

What is the taxonomy code for Crystal Fuller?

The primary taxonomy code is 156FX1800X – Optician.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.