Provider Demographics
NPI:1902803323
Name:FULP, CATHY A (OD)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:A
Last Name:FULP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4370
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-4370
Mailing Address - Country:US
Mailing Address - Phone:336-434-4033
Mailing Address - Fax:336-434-6680
Practice Address - Street 1:10564 N MAIN ST
Practice Address - Street 2:STE E
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-2472
Practice Address - Country:US
Practice Address - Phone:336-434-4033
Practice Address - Fax:336-434-4035
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1388152W00000X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890929AMedicaid
NC0929AOtherBCBSNC
NC2467548EMedicare ID - Type Unspecified
NC2467548FMedicare ID - Type Unspecified
NC0929AOtherBCBSNC
NCU13798Medicare UPIN